Provider Demographics
NPI:1780164897
Name:PHILLIPS, ANDREW D (LMFT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 LAKESHORE DR SW
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3038
Mailing Address - Country:US
Mailing Address - Phone:404-693-5251
Mailing Address - Fax:
Practice Address - Street 1:4045 ORCHARD RD SE STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4904
Practice Address - Country:US
Practice Address - Phone:404-693-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001627106H00000X
CA106511106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist