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General NPI Number Information
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NPI Number | 1982963328
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Entity Type | Organization
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Legal Business Name | PHOENIX COUNSELING SERVICES
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 8609 SUDLEY RD SUITE 201
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City | MANASSAS
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State | VA
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Zip | 20110-8321
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Country | US
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Telephone | 703-577-1492
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Fax | 703-530-8801
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Provider Business Mailing Address
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Address Line | 8609 SUDLEY RD SUITE 201
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City | MANASSAS
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State | VA
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Zip | 20110-8321
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Country | US
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Telephone | 703-577-1492
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Fax | 703-530-8801
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Authorized Official
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Title or Position | CEO
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Name | ROSELLE STARK
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Credential | CNS
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Telephone | 703-577-1492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0015000582
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License Number State | VA
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