Provider Demographics
NPI:1497847628
Name:PHIPPS, EDNA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:EDNA
Middle Name:M
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6812 KILCHURN CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-7249
Mailing Address - Country:US
Mailing Address - Phone:804-221-0813
Mailing Address - Fax:434-336-1516
Practice Address - Street 1:139 C BAKER STREET
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23287
Practice Address - Country:US
Practice Address - Phone:804-221-0813
Practice Address - Fax:434-336-1516
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750610465Medicaid