Provider Demographics
NPI:1922747831
Name:PHILLIPS, DUSTIN B (MS, LCADC, CAIMHP)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:B
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MS, LCADC, CAIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SCARLET DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8070
Mailing Address - Country:US
Mailing Address - Phone:606-595-3218
Mailing Address - Fax:
Practice Address - Street 1:26 SCARLET DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8070
Practice Address - Country:US
Practice Address - Phone:606-595-3218
Practice Address - Fax:606-215-8372
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)