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General NPI Number Information
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NPI Number | 1952056459
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Entity Type | Individual
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Provider Name | THEANNAH REMI LOUISE PHILLIPS LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 1 HARRISON ST SE
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City | LEESBURG
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State | VA
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Zip | 20175-3102
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Country | US
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Telephone | 703-777-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 1179 T J JACKSON DR STE B
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City | FALLING WATERS
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State | WV
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Zip | 25419-4698
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Country | US
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Telephone | 304-278-4433
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34106
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00945849
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904017827
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License Number State | VA
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