Provider Demographics
NPI:1225801996
Name:SWANN, PHILLIP DANIEL JR
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DANIEL
Last Name:SWANN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7641 HULL STREET RD STE 205
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6444
Mailing Address - Country:US
Mailing Address - Phone:804-728-2772
Mailing Address - Fax:804-728-2771
Practice Address - Street 1:7641 HULL STREET RD STE 205
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6444
Practice Address - Country:US
Practice Address - Phone:804-728-2772
Practice Address - Fax:804-728-2771
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health