Provider Demographics
NPI:1083712731
Name:SPAHN, PHYLLIS (LPC, NCC, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:
Last Name:SPAHN
Suffix:
Gender:F
Credentials:LPC, NCC, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 692
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-0692
Mailing Address - Country:US
Mailing Address - Phone:706-275-8104
Mailing Address - Fax:706-275-8134
Practice Address - Street 1:203 N THORNTON AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-4273
Practice Address - Country:US
Practice Address - Phone:706-275-8104
Practice Address - Fax:706-275-8134
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional