Provider Demographics
NPI:1144267998
Name:NEWMAN, PHYLLIS (LPC)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N FANT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5720
Mailing Address - Country:US
Mailing Address - Phone:864-226-1166
Mailing Address - Fax:864-226-5647
Practice Address - Street 1:400 N FANT ST
Practice Address - Street 2:SUITE D
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5720
Practice Address - Country:US
Practice Address - Phone:864-226-1166
Practice Address - Fax:864-226-5647
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
F91740Medicare UPIN
8132Medicare PIN