MEDICARE: PHOENIX RISING COUNSELING AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1972441517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX RISING COUNSELING AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1002 LEE ST E # 11
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1700
Country	:	US
Telephone Number	:	304-691-9379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 LEE ST E # 11
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1700
Country	:	US
Telephone Number	:	304-691-9379
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	KIMBERLY SUE MASSIE
Credential	:	MA, LPC
Telephone Number	:	304-691-9379

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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