Healthcare Provider Details

I. General information

NPI: 1255579983
Provider Name (Legal Business Name): PHASES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BEL AIR BLVD SUITE 404
MOBILE AL
36606-3513
US

IV. Provider business mailing address

601 BEL AIR BLVD SUITE 404
MOBILE AL
36606-3513
US

V. Phone/Fax

Practice location:
  • Phone: 251-478-5050
  • Fax: 251-478-5015
Mailing address:
  • Phone: 251-478-5050
  • Fax: 251-478-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0832
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2085
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number628
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1352
License Number StateAL

VIII. Authorized Official

Name: MS. HELENA F ROLDAN
Title or Position: OWNER
Credential: LPC, CADC
Phone: 251-478-5050