Healthcare Provider Details

I. General information

NPI: 1831377563
Provider Name (Legal Business Name): PHOENIX COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 07/21/2022
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 N LAFAYETTE ST STE 2
SHELBY NC
28150-3898
US

IV. Provider business mailing address

839 MAJESTIC CT STE 1
GASTONIA NC
28054-5152
US

V. Phone/Fax

Practice location:
  • Phone: 704-476-4106
  • Fax:
Mailing address:
  • Phone: 704-396-6747
  • Fax: 704-854-4860

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 StateNC
# 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: 704-921-3070