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General NPI Number Information
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NPI Number | 1942721485
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Entity Type | Individual
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Provider Name | GREGORY NEILL PHILLIPS LCSWA, LCASA
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Gender | Male
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 1014 HAY ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5316
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Country | US
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Telephone | 910-500-3046
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Fax | 910-900-3100
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Provider Business Mailing Address
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Address Line | 5579 HALLWOOD DR
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City | HOPE MILLS
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State | NC
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Zip | 28348-2864
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Country | US
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Telephone | 910-689-5621
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 23146
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PO12034
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P016042
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License Number State | NC
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