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General NPI Number Information
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NPI Number | 1588390967
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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 | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 377 VALLEY RD # 1250
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City | CLIFTON
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State | NJ
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Zip | 07013-1319
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Country | US
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Telephone | 917-994-0287
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Fax |
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Provider Business Mailing Address
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Address Line | 377 VALLEY RD # 1250
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City | CLIFTON
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State | NJ
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Zip | 07013-1319
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Country | US
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Telephone | 917-994-0287
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH CLINICIAN/DIRECTOR
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Name | DESIREE A LINTON-DUDLEY
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Credential | LPC, LMHC
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Telephone | 179-940-2879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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