Healthcare Provider Details

I. General information

NPI: 1265378046
Provider Name (Legal Business Name): PHOENIX THERAPEUTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 VANDORA SPRINGS RD
GARNER NC
27529-3543
US

IV. Provider business mailing address

127 W HARGETT ST STE 301
RALEIGH NC
27601-1351
US

V. Phone/Fax

Practice location:
  • Phone: 919-996-0707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JARRETT CHRISTIAN BLAIZE
Title or Position: OWNER
Credential: LCSW
Phone: 919-996-0707