Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 17917 | MD |
Y | 1041C0700X | Clinical Social Worker | LC50078554 | DC |
NPI | 1003171224 |
---|---|
Provider Name | Janelle Ayana Phillip |
First Address | Laurel, MD 20707-3744 |
Second Address | Washington, DC 20422-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2012 |
Last Update Date | 13/07/2012 |