Provider Demographics
NPI:1366774192
Name:PHILLIPS, SUSAN EDMONDSON (MS, CGC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:EDMONDSON
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 GLENN MITCHELL DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0179
Mailing Address - Country:US
Mailing Address - Phone:757-689-5104
Mailing Address - Fax:757-689-2717
Practice Address - Street 1:2075 GLENN MITCHELL DR
Practice Address - Street 2:SUITE 500
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0179
Practice Address - Country:US
Practice Address - Phone:757-689-5104
Practice Address - Fax:757-689-2717
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS