Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1023590239 |
---|---|
Provider Name | Lisa Phillips |
First Address | Baltimore, MD 21207-5579 |
Second Address | Baltimore, MD 21207-5579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2018 |
Last Update Date | 04/09/2018 |