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General NPI Number Information
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NPI Number | 1659962728
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Entity Type | Organization
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Legal Business Name | PHOENIX BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 02/01/2021
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 31 PINE STREET, SUITE 207
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City | NORFOLK
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State | MA
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Zip | 02056
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Country | US
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Telephone | 508-623-3931
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Fax | 508-623-3939
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Provider Business Mailing Address
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Address Line | 2490 MAPLE SWAMP ROAD
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City | NORTH DIGHTON
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State | MA
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Zip | 02764
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Country | US
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Telephone | 508-685-5436
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAWN LORRAINE PARKS
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Credential | PHD, LMHC CADC
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Telephone | 508-623-3931
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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 |
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License Number State |
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