Provider Demographics
NPI:1497710131
Name:GREENWOOD, PHILIP DAVIS (PHD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:DAVIS
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 TIMBER OAK CT
Mailing Address - Street 2:OAKDALE CIRCLE
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3459
Mailing Address - Country:US
Mailing Address - Phone:434-237-6236
Mailing Address - Fax:434-237-9155
Practice Address - Street 1:66 TIMBER OAK CT
Practice Address - Street 2:OAKDALE CIRCLE
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3459
Practice Address - Country:US
Practice Address - Phone:434-237-6236
Practice Address - Fax:434-237-9155
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001150101YP2500X
VA0717000128106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA032983OtherBCBS
VA291135000OtherMAGELLAN
VA088681OtherSENTARA
VA031181OtherVALUE OPTIONS