Provider Demographics
NPI:1235537218
Name:PHILLIPS, WENDY G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:G
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10299 WOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4419
Mailing Address - Country:US
Mailing Address - Phone:804-727-8488
Mailing Address - Fax:
Practice Address - Street 1:1041 SHARON RD STE 201
Practice Address - Street 2:
Practice Address - City:KING WILLIAM
Practice Address - State:VA
Practice Address - Zip Code:23086-3344
Practice Address - Country:US
Practice Address - Phone:804-769-2751
Practice Address - Fax:804-769-3125
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040086581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ49480AMedicare UPIN