Individual
MRS. STACY BUSH PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 MILL RACE DR, SALEM, VA 24153-3137
(540) 589-1620
Mailing address
1060 GREEN RIDGE RD, CHRISTIANSBURG, VA 24073-9501
(540) 589-1620
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
904716
VA
Other
Enumeration date
12/11/2019
Last updated
12/11/2019
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