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General NPI Number Information
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NPI Number | 1093277048
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Entity Type | Organization
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Legal Business Name | RISING PHOENIX COUNSELING, LLC
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 366 E GRAVES AVE STE D
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City | ORANGE CITY
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State | FL
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Zip | 32763-5266
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Country | US
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Telephone | 407-777-2596
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Fax |
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Provider Business Mailing Address
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Address Line | 130 SUNRISE BLVD
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City | DEBARY
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State | FL
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Zip | 32713-3849
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Country | US
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Telephone | 386-837-2362
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID ALLEN MARTIN
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Credential | LMFT
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Telephone | 386-837-2362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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