Healthcare Provider Details

I. General information

NPI: 1942721485
Provider Name (Legal Business Name): GREGORY NEILL PHILLIPS LCSWA, LCASA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 W PROSPECT AVE
RAEFORD NC
28376-2512
US

IV. Provider business mailing address

5579 HALLWOOD DR
HOPE MILLS NC
28348-2864
US

V. Phone/Fax

Practice location:
  • Phone: 910-875-5590
  • Fax: 910-875-5008
Mailing address:
  • Phone: 910-689-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23146
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016042
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: