MEDICARE: GEORGIA PHILLIPS 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
1	1041C0700X	Clinical Social Worker	0904003466	VA

General Provider Information

NPI Number	:	1538523972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIA PHILLIPS LCSW

Provider Business Mailing Address
First Line	:	1300 DIAMOND SPRINGS ROAD
Second Line	:	SUITE 503
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3645
Country	:	US
Telephone Number	:	757-656-1665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 DIAMOND SPRINGS RD
Second Line	:	SUITE 503
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3645
Country	:	US
Telephone Number	:	757-656-1665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	04/12/2016

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Directions to “ GEORGIA PHILLIPS LCSW” Practice Location

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