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General NPI Number Information
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NPI Number | 1104712561
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Entity Type | Individual
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Provider Name | RYAN ANDREW PHILLIPS LCSWA
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Gender | Male
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 5611 NC HIGHWAY 55 STE 103
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City | DURHAM
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State | NC
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Zip | 27713-4395
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Country | US
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Telephone | 919-617-9656
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Fax | 919-561-6883
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Provider Business Mailing Address
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Address Line | 8406 SIX FORKS RD STE 204
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City | RALEIGH
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State | NC
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Zip | 27615-3074
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Country | US
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Telephone | 919-617-9656
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Fax | 919-561-6883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P022245
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License Number State | NC
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