Shane Phillips, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C013024 Issued in NC

Practice address

6112 Saint Giles St
Raleigh, NC 27612-7043

Phone

(919) 893-4465

NPI assigned

Mar 8, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Private Diagnostic Clinic, PLLC

  • Psychologist
  • Cary, NC
  • NPI 1326598459
  NPD (past)
• Regional Psychiatry, PLLC

  • Adult Mental Health Clinic/Center
  • Cary, NC
  • NPI 1639298714
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1588166243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6112 SAINT GILES ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276127043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6112 SAINT GILES ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276127043",
            "telephone_number": "919-893-4465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "411 Trent Drive",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277100001",
            "country_code": "US",
            "telephone_number": "404-783-2603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "123 Hendersonville Rd",
            "address_purpose": "LOCATION",
            "city": "Asheville",
            "state": "NC",
            "postal_code": "288032868",
            "country_code": "US",
            "telephone_number": "828-257-4730",
            "fax_number": "828-232-2942",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "218 E Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Asheville",
            "state": "NC",
            "postal_code": "288012570",
            "country_code": "US",
            "telephone_number": "828-419-4432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "SHANE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-08",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "23890",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "PO11867",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C013024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Duncan Phillips
• Kerry Phillips, RD, LDN
• Kristi Suzanne Phillips, MS CCC-SLP
• Sabrina Phillips, PHARMD
• Sandra K. Phillips
• Stephanie Dawn Phillips, M.ED., LPC, NCC,CCTP
• Taya Phillips
• Thomas Andrew Phillips, LAT, ATC
• Tiara Amber Phillips, APRN
• Tracey Boykin Phillips, FNP-C

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.