Provider Demographics
NPI:1073216677
Name:PHOENIX WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:PHOENIX WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, LCMHC
Authorized Official - Phone:919-249-7477
Mailing Address - Street 1:209 S POINTE DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9946
Mailing Address - Country:US
Mailing Address - Phone:252-481-3809
Mailing Address - Fax:
Practice Address - Street 1:155 N MARKET ST STE 107
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-5285
Practice Address - Country:US
Practice Address - Phone:252-481-3809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty