Provider Demographics
NPI:1881657773
Name:GREENBRIER CENTER FOR BEHAVIORAL MEDICINE P C
Entity Type:Organization
Organization Name:GREENBRIER CENTER FOR BEHAVIORAL MEDICINE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FAUSTINO
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-547-1638
Mailing Address - Street 1:1206 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-9400
Mailing Address - Country:US
Mailing Address - Phone:757-547-1638
Mailing Address - Fax:757-549-0663
Practice Address - Street 1:3755 E VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3238
Practice Address - Country:US
Practice Address - Phone:757-664-7699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010461362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B35386Medicare UPIN