Provider Demographics
NPI:1629387279
Name:PHILLIPS, BRANDON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WHITEWOOD RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1668
Mailing Address - Country:US
Mailing Address - Phone:434-327-2875
Mailing Address - Fax:
Practice Address - Street 1:90 WHITEWOOD RD STE 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1668
Practice Address - Country:US
Practice Address - Phone:434-327-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004103103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist