Healthcare Provider Details

I. General information

NPI: 1477065415
Provider Name (Legal Business Name): PHOENIX COUNSELING AND RECOVERY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 KINDLEY ST
GREENSBORO NC
27406-4213
US

IV. Provider business mailing address

1102 KINDLEY ST
GREENSBORO NC
27406-4213
US

V. Phone/Fax

Practice location:
  • Phone: 336-458-7135
  • Fax:
Mailing address:
  • Phone: 336-458-7135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCAS-22298
License Number StateNC

VIII. Authorized Official

Name: SARDIE ROCHELLE IZZARD
Title or Position: OWNER/ THERAPIST
Credential: LCSW-A
Phone: 336-458-7135