MEDICARE: PHOENIX RISING THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1851966055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX RISING THERAPY LLC

Provider Business Mailing Address
First Line	:	100 E MAIN ST STE 502
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5079
Country	:	US
Telephone Number	:	410-397-5176
Fax Number	:	855-975-2477

Provider Business Practice Location Address
First Line	:	540 RIVERSIDE DR STE 15
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5352
Country	:	US
Telephone Number	:	443-358-6904
Fax Number	:	855-975-2477

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. TONI C STURGIS
Credential	:	LCPC
Telephone Number	:	410-397-5176

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	01/21/2026

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Directions to “PHOENIX RISING THERAPY LLC ” Practice Location

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