Healthcare Provider Details

I. General information

NPI: 1902074768
Provider Name (Legal Business Name): PHOENIX COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S ASPEN ST
LINCOLNTON NC
28092-2735
US

IV. Provider business mailing address

631 BRAWLEY SCHOOL RD SUITE 200B, PMB 301
MOORESVILLE NC
28117-6204
US

V. Phone/Fax

Practice location:
  • Phone: 704-735-7719
  • Fax: 704-921-3066
Mailing address:
  • Phone: 704-360-4531
  • Fax: 704-360-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. KEVIN PAUL OLIVER
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, MPA
Phone: 704-491-0829