Healthcare Provider Details

I. General information

NPI: 1982533543
Provider Name (Legal Business Name): CARLESS JAMES ALAN PHILLIPS BA PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 KANAWHA ST
SAINT ALBANS WV
25177-2228
US

IV. Provider business mailing address

712 COLONY DR
CHARLESTON WV
25314-1790
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7851
  • Fax: 304-722-0189
Mailing address:
  • Phone: 681-385-1124
  • Fax: 304-727-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: