Healthcare Provider Details

I. General information

NPI: 1104712561
Provider Name (Legal Business Name): RYAN ANDREW PHILLIPS LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5611 NC HIGHWAY 55 STE 103
DURHAM NC
27713-4395
US

IV. Provider business mailing address

8406 SIX FORKS RD STE 204
RALEIGH NC
27615-3074
US

V. Phone/Fax

Practice location:
  • Phone: 919-617-9656
  • Fax: 919-561-6883
Mailing address:
  • Phone: 919-617-9656
  • Fax: 919-561-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022245
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: