Healthcare Provider Details

I. General information

NPI: 1124754122
Provider Name (Legal Business Name): PHOENIX COUNSELING COLLABORATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N WHITE ST
DOBSON NC
27017-8938
US

IV. Provider business mailing address

PO BOX 823
DOBSON NC
27017-0823
US

V. Phone/Fax

Practice location:
  • Phone: 336-443-4076
  • Fax: 336-443-4126
Mailing address:
  • Phone: 336-443-4076
  • Fax: 336-443-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MONICA NICHOLS-ARMSTRONG
Title or Position: PROGRAM DIRECTOR
Credential: MA, LCAS, CSI
Phone: 336-414-7794