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General NPI Number Information
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NPI Number | 1770163990
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Entity Type | Organization
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Legal Business Name | PHOENIX RISING BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 120 VILLAGE CIR
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City | SENOIA
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State | GA
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Zip | 30276-3374
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Country | US
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Telephone | 470-447-2129
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Fax | 470-447-2139
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Provider Business Mailing Address
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Address Line | 120 VILLAGE CIR
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City | SENOIA
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State | GA
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Zip | 30276-3374
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Country | US
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Telephone | 470-447-2129
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Fax | 470-447-2139
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA ANNI SKURJA
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Credential | LMFT
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Telephone | 470-447-2129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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