Provider Demographics
NPI:1184673667
Name:PHILLIPS, RALEIGH CHESTER III (PSY D)
Entity Type:Individual
Prefix:DR
First Name:RALEIGH
Middle Name:CHESTER
Last Name:PHILLIPS
Suffix:III
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:110 KINGSLEY LN
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4614
Mailing Address - Country:US
Mailing Address - Phone:757-489-4700
Mailing Address - Fax:757-489-0240
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 401
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-489-4700
Practice Address - Fax:757-489-0240
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA1810001212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA680000116Medicare UPIN