Healthcare Provider Details

I. General information

NPI: 1245116110
Provider Name (Legal Business Name): PHOENIX RISING BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 STATE ST APT 3
AUGUSTA ME
04330-6432
US

IV. Provider business mailing address

183 STATE ST APT 3
AUGUSTA ME
04330-6432
US

V. Phone/Fax

Practice location:
  • Phone: 207-313-1881
  • Fax: 207-742-4231
Mailing address:
  • Phone: 207-313-1881
  • Fax: 207-742-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA M GOULET
Title or Position: CEO
Credential: MHRTC
Phone: 207-313-1881