Provider Demographics
NPI:1063550960
Name:MILLER PHILLIPS, KANDACE LEANNE (BS CSAC)
Entity type:Individual
Prefix:MRS
First Name:KANDACE
Middle Name:LEANNE
Last Name:MILLER PHILLIPS
Suffix:
Gender:F
Credentials:BS CSAC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:610 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2589
Practice Address - Country:US
Practice Address - Phone:276-525-1550
Practice Address - Fax:276-525-1609
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710101919101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)