Healthcare Provider Details

I. General information

NPI: 1497710131
Provider Name (Legal Business Name): PHILIP DAVIS GREENWOOD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 TIMBER OAK CT OAKDALE CIRCLE
LYNCHBURG VA
24502-3459
US

IV. Provider business mailing address

66 TIMBER OAK CT OAKDALE CIRCLE
LYNCHBURG VA
24502-3459
US

V. Phone/Fax

Practice location:
  • Phone: 434-237-6236
  • Fax: 434-237-9155
Mailing address:
  • Phone: 434-237-6236
  • Fax: 434-237-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001150
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000128
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: