Provider Demographics
NPI:1306483698
Name:PHILLIPS, CHARLOTTE C (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 72ND ST UNIT 105
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-5263
Mailing Address - Country:US
Mailing Address - Phone:443-604-0998
Mailing Address - Fax:
Practice Address - Street 1:830 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15233-1772
Practice Address - Country:US
Practice Address - Phone:412-322-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional