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General NPI Number Information
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NPI Number | 1841110947
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Entity Type | Organization
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Legal Business Name | FYREBIRD RECOVERY
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Dates
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Enumeration Date | 07/18/2026
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Last Update Date | 07/18/2026
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Provider Practice Location Address
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Address Line | 4924 HIGHWAY 17 BYP S UNIT J
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-1605
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Country | US
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Telephone | 843-691-0074
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Fax |
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Provider Business Mailing Address
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Address Line | 4924 HIGHWAY 17 BYP S UNIT J
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City | MYRTLE BEACH
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State | SC
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Zip | 29588-1605
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Country | US
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Telephone | 843-691-0074
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AZHANE POWELL
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Credential | LISW-CP
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Telephone | 518-375-0904
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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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