MEDICARE: GREENBRIER CENTER FOR BEHAVIORAL MEDICINE P C

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	2084P0800X	Psychiatry Physician	0101046136	VA

General Provider Information

NPI Number	:	1881657773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBRIER CENTER FOR BEHAVIORAL MEDICINE P C

Provider Business Mailing Address
First Line	:	1206 FAIRWAY DR
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-9400
Country	:	US
Telephone Number	:	757-547-1638
Fax Number	:	757-549-0663

Provider Business Practice Location Address
First Line	:	3755 E VIRGINIA BEACH BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-3238
Country	:	US
Telephone Number	:	757-664-7699
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DR. LUIS FAUSTINO IGNACIO
Credential	:	MD
Telephone Number	:	757-547-1638

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	08/22/2020

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