Provider Demographics
NPI:1568714624
Name:PHILLIPS PROGRAMS
Entity Type:Organization
Organization Name:PHILLIPS PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE AND DATA COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:703-941-8810
Mailing Address - Street 1:7010 BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6006
Mailing Address - Country:US
Mailing Address - Phone:703-941-8810
Mailing Address - Fax:703-658-2378
Practice Address - Street 1:7010 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6006
Practice Address - Country:US
Practice Address - Phone:703-941-8810
Practice Address - Fax:703-658-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA16471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659453231Medicaid