Provider Demographics
NPI:1619856846
Name:PHILLIPS, LINDA ITZEL
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ITZEL
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 WARWICK DR UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3589
Mailing Address - Country:US
Mailing Address - Phone:919-358-1750
Mailing Address - Fax:
Practice Address - Street 1:1606 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3518
Practice Address - Country:US
Practice Address - Phone:336-214-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0227501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical