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General NPI Number Information
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NPI Number | 1841703303
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Entity Type | Individual
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Provider Name | CORINNE NAOMI PHILLIPS LPC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 3235 ELECTRIC RD BLDG B
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City | ROANOKE
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State | VA
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Zip | 24018-0192
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Country | US
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Telephone | 423-863-8663
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Fax |
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Provider Business Mailing Address
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Address Line | 3102 WOODLAWN AVE SW
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City | ROANOKE
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State | VA
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Zip | 24015-4226
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Country | US
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Telephone | 423-863-8663
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3713
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007018
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License Number State | VA
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