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General NPI Number Information
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NPI Number | 1245658947
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Entity Type | Individual
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Provider Name | ROBERT TERRY PHILLIPS LPC
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Gender | Male
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 10/30/2022
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Provider Practice Location Address
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Address Line | 2137 LAKESIDE DR STE 103
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City | LYNCHBURG
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State | VA
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Zip | 24501-6808
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Country | US
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Telephone | 434-260-3042
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 ASHLEY DR
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City | LYNCHBURG
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State | VA
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Zip | 24501-2210
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Country | US
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Telephone | 434-907-9719
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Fax | 434-907-9705
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701008347
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License Number State | VA
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