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General NPI Number Information
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NPI Number | 1366362196
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Entity Type | Organization
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Legal Business Name | PHOENIX HOUSE OF HOPE INC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 2561 SW GROTTO CIR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2927
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Country | US
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Telephone | 772-236-3402
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Fax | 772-236-3402
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Provider Business Mailing Address
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Address Line | 2561 SW GROTTO CIR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2927
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Country | US
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Telephone | 772-236-3402
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Fax | 772-236-3402
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Authorized Official
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Title or Position | MSW
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Name | PHOENIX HOUSE OF HOPE INC LAURENCEAU
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Credential |
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Telephone | 786-326-8742
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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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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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