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General NPI Number Information
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NPI Number | 1629461959
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Entity Type | Organization
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Legal Business Name | PHOENIX PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 204 MUIRS CHAPEL RD
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City | GREENSBORO
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State | NC
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Zip | 27410-6173
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Country | US
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Telephone | 336-645-5507
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Fax | 336-834-0442
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Provider Business Mailing Address
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Address Line | 204 MUIRS CHAPEL RD
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City | GREENSBORO
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State | NC
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Zip | 27410-6173
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Country | US
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Telephone | 336-645-5507
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Fax | 336-834-0442
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. RUBY LEWIS-DODD
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Credential | M.A
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Telephone | 336-645-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A11260
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License Number State | NC
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