Healthcare Provider Details

I. General information

NPI: 1205745627
Provider Name (Legal Business Name): DON ALLEN PHILLIPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 WILLCROFT DR
SUMTER SC
29154-8028
US

IV. Provider business mailing address

1110 WILLCROFT DR
SUMTER SC
29154-8028
US

V. Phone/Fax

Practice location:
  • Phone: 803-521-0416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12547
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: