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General NPI Number Information
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NPI Number | 1215698915
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALING GROUP
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 10 CORPORATE CIR STE 201
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City | NEW CASTLE
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State | DE
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Zip | 19720-2418
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Country | US
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Telephone | 610-761-2129
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Fax |
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Provider Business Mailing Address
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Address Line | 607 HELMSDALE CIR
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City | NEW CASTLE
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State | DE
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Zip | 19720-3830
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Country | US
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Telephone | 610-761-2129
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS LASHAWN JANELL WATERS
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Credential | LPCMH
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Telephone | 610-761-2129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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