MEDICARE: PHILLIP THOMAS

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	101YP2500X	Professional Counselor	0701006533	VA

General Provider Information

NPI Number	:	1902266844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP THOMAS

Provider Business Mailing Address
First Line	:	380 CLEVELAND PL
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6529
Country	:	US
Telephone Number	:	757-233-0003
Fax Number	:	757-233-1669

Provider Business Practice Location Address
First Line	:	380 CLEVELAND PL
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6529
Country	:	US
Telephone Number	:	757-233-0003
Fax Number	:	757-233-1669

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

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	03/04/2016

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