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General NPI Number Information
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NPI Number | 1265885610
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Entity Type | Organization
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Legal Business Name | PHOENIX TRAINING INSTITUTE
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 1147 W LIBERTY ST
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City | ALLENTOWN
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State | PA
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Zip | 18102-2738
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Country | US
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Telephone | 610-737-0499
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Fax |
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Provider Business Mailing Address
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Address Line | 1147 W LIBERTY ST
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City | ALLENTOWN
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State | PA
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Zip | 18102-2738
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LARUE CARRIGAN-HOUSER
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Credential | MHS,CADC,LPC,CCJP
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Telephone | 610-737-0499
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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 | 397049
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License Number State | PA
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