Provider Demographics
NPI:1063766400
Name:PHILLIPS-WHITE, COLLEEN ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELLEN
Last Name:PHILLIPS-WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WEST THAMES ST, BLDG 301
Mailing Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-859-4629
Mailing Address - Fax:860-859-4725
Practice Address - Street 1:401 WEST THAMES ST, BLDG 301
Practice Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-859-4629
Practice Address - Fax:860-859-4725
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical