Healthcare Provider Details

I. General information

NPI: 1982909214
Provider Name (Legal Business Name): DANNY C PHIPPS DOCTOR OF MINISTRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 09/28/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 VILLAGE RD STE 1
SHALLOTTE NC
28470-3434
US

IV. Provider business mailing address

632 VILLAGE RD # BOX
SHALLOTTE NC
28470-3435
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-5727
  • Fax: 910-754-5797
Mailing address:
  • Phone: 910-754-5727
  • Fax: 910-754-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number531
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number531
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: