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General NPI Number Information
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NPI Number | 1801214986
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Entity Type | Organization
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Legal Business Name | PHOENIX PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 29 CONNECTICUT BLVD
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City | EAST HARTFORD
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State | CT
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Zip | 06108-3008
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Country | US
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Telephone | 860-778-1257
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Fax |
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Provider Business Mailing Address
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Address Line | 29 CONNECTICUT BLVD
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City | EAST HARTFORD
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State | CT
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Zip | 06108-3008
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Country | US
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Telephone | 860-778-1257
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. TAMAR DRAUGHN
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Credential | LPC
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Telephone | 860-680-9440
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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 | 002311
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License Number State | CT
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