Individual
PHILIP GLEN BASCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
655 7TH ST BLDG 700, ROBINS AFB, GA 31098-2227
(850) 461-2083
Mailing address
655 7TH ST BLDG 700, ROBINS AFB, GA 31098-2227
(850) 461-2083
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC4245
ME
Other
Enumeration date
09/07/2005
Last updated
09/07/2010
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