Provider Demographics
NPI:1114323367
Name:ERICSON-DAVIS, PHYLLIS (PHD)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:ERICSON-DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PHYLLIS
Other - Middle Name:ERICSON
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 SEATTLE SLEW LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-7901
Mailing Address - Country:US
Mailing Address - Phone:864-449-4867
Mailing Address - Fax:
Practice Address - Street 1:101 SEATTLE SLEW LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-7901
Practice Address - Country:US
Practice Address - Phone:864-449-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA#75132117101YP1600X
103TP0814X, 103TP2701X, 103TF0200X, 103TF0000X, 103TC1900X, 103TC2200X, 101YA0400X, 101YM0800X, 103TB0200X, 101YP2500X, 106H00000X, 103TM1800X, 103TS0200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service