MEDICARE: JOYCE PHILLIPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	4726	NC

General Provider Information

NPI Number	:	1215198684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE PHILLIPS

Provider Business Mailing Address
First Line	:	12026 MASON DR
Second Line	:
City	:	QUANTICO
State	:	VA
Zip	:	22134-2084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12026 MASON DR
Second Line	:
City	:	QUANTICO
State	:	VA
Zip	:	22134-2084
Country	:	US
Telephone Number	:	703-842-7984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	06/18/2008

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