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NPI Code Detail

MEDICARE: PHILLIS D BLOW WILSON LCSW

MEDICARE: PHILLIS D BLOW WILSON LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0904005150VA

General Provider Information

NPI Number : 1215223805
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIS D BLOW WILSON LCSW
Provider Business Mailing Address
First Line : 7460 CENTRAL BUSINESS PARK DR
Second Line :
City : NORFOLK
State : VA
Zip : 23513-2818
Country : US
Telephone Number : 757-289-5885
Fax Number : 757-622-2011
Provider Business Practice Location Address
First Line : 7460 CENTRAL BUSINESS PARK DR
Second Line :
City : NORFOLK
State : VA
Zip : 23513-2818
Country : US
Telephone Number : 757-289-5885
Fax Number : 757-622-2011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2011
Last Update Date : 06/22/2011

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