Provider Demographics
NPI:1063081255
Name:PHILLIPS, WARREN (LMSW)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 ADLUH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4462
Mailing Address - Country:US
Mailing Address - Phone:314-603-3492
Mailing Address - Fax:
Practice Address - Street 1:1470 BEN SAWYER BLVD STE 6
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4593
Practice Address - Country:US
Practice Address - Phone:843-352-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12856104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker