Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | DC |
NPI | 1023445939 |
---|---|
Provider Name | Dr. Carlos William Phillip |
First Address | Lanham, MD 20706-2774 |
Second Address | Washington Dc, DC 20019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2013 |
Last Update Date | 09/10/2013 |