Provider Demographics
NPI:1144512872
Name:PHIPPS, SYDNEY M (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:M
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 FARMINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5551
Mailing Address - Country:US
Mailing Address - Phone:704-536-6853
Mailing Address - Fax:704-445-4582
Practice Address - Street 1:1201 S POST RD # 100
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152
Practice Address - Country:US
Practice Address - Phone:704-481-7001
Practice Address - Fax:704-445-4582
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-3094101YA0400X
NCC0098621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3094-AOtherLCAS-A