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General NPI Number Information
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NPI Number | 1275839250
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Entity Type | Organization
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Legal Business Name | PHIPPS FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 139C BAKER ST
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City | EMPORIA
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State | VA
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Zip | 23847-1703
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Country | US
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Telephone | 434-336-1516
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Fax | 434-336-1517
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Provider Business Mailing Address
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Address Line | 139C BAKER ST
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City | EMPORIA
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State | VA
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Zip | 23847-1703
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Country | US
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Telephone | 434-336-1516
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Fax | 434-336-1517
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Authorized Official
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Title or Position | PERSIDENT
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Name | EDNA M. PHIPPS
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Credential | LCSW
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Telephone | 434-336-1516
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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 | 0904002630
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License Number State | VA
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