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General NPI Number Information
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NPI Number | 1477065415
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Entity Type | Organization
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Legal Business Name | PHOENIX COUNSELING AND RECOVERY SERVICES, LLC
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 1102 KINDLEY ST
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City | GREENSBORO
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State | NC
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Zip | 27406-4213
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Country | US
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Telephone | 336-458-7135
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Fax |
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Provider Business Mailing Address
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Address Line | 405 BATTLEGROUND AVE STE 203
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City | GREENSBORO
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State | NC
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Zip | 27401-2153
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Country | US
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Telephone | 335-550-4558
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS SARDIE ROCHELLE IZZARD
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Credential | LCAS-A, LCSW-A
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Telephone | 336-550-4558
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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 | LCAS-22298
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License Number State | NC
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