Healthcare Provider Details

I. General information

NPI: 1275921066
Provider Name (Legal Business Name): PHOENIX BEHAVIORAL CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 THE TER
HAGERSTOWN MD
21742-3227
US

IV. Provider business mailing address

101 KING ST
HAGERSTOWN MD
21740-5732
US

V. Phone/Fax

Practice location:
  • Phone: 240-420-0000
  • Fax: 240-420-0002
Mailing address:
  • Phone: 240-420-0000
  • Fax: 240-420-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. JOY RAMSAY FARAH
Title or Position: CHIEF MEDICAL DIRECTOR
Credential: M.D.
Phone: 240-420-0000