Healthcare Provider Details

I. General information

NPI: 1083544878
Provider Name (Legal Business Name): PHOENIX RISING WELLNESS & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 RIVERPLACE BLVD APT 2503
JACKSONVILLE FL
32207-1823
US

IV. Provider business mailing address

1401 RIVERPLACE BLVD APT 2503
JACKSONVILLE FL
32207-1823
US

V. Phone/Fax

Practice location:
  • Phone: 904-469-6878
  • Fax:
Mailing address:
  • Phone: 904-469-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAKINA MCCOY
Title or Position: OWNER/COUNSELOR
Credential: LMHC
Phone: 904-469-6878