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General NPI Number Information
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NPI Number | 1073216677
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Entity Type | Organization
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Legal Business Name | PHOENIX WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 155 N MARKET ST STE 107
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City | WASHINGTON
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State | NC
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Zip | 27889-5285
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Country | US
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Telephone | 252-481-3809
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Fax |
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Provider Business Mailing Address
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Address Line | 209 S POINTE DR UNIT B
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City | WINTERVILLE
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State | NC
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Zip | 28590-9946
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Country | US
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Telephone | 252-481-3809
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Fax |
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | BRANDY JONES
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Credential | LCAS, LCMHC
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Telephone | 919-249-7477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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