Healthcare Provider Details

I. General information

NPI: 1467981316
Provider Name (Legal Business Name): NICHOLE AURA PHILLIPS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BUFORD RD STE 201
NORTH CHESTERFIELD VA
23235-5292
US

IV. Provider business mailing address

13030 QUEENSGATE RD
MIDLOTHIAN VA
23114-4470
US

V. Phone/Fax

Practice location:
  • Phone: 804-447-3403
  • Fax: 804-323-1107
Mailing address:
  • Phone: 804-878-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701007069
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007069
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: