Healthcare Provider Details

I. General information

NPI: 1245068907
Provider Name (Legal Business Name): AMY'S RISING PHOENIX COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 BATTLEGROUND AVE STE 4
GREENSBORO NC
27408-2636
US

IV. Provider business mailing address

2710 CHADBURY DR
GREENSBORO NC
27407-6697
US

V. Phone/Fax

Practice location:
  • Phone: 336-265-2720
  • Fax: 336-265-2721
Mailing address:
  • Phone: 336-987-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY LEIGH O'HEARN
Title or Position: OWNER
Credential: LCSW, LCAS
Phone: 336-265-2720