Provider Demographics
NPI:1114386166
Name:PHOENIX RISING COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PHOENIX RISING COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAOLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:570-575-3195
Mailing Address - Street 1:1512 E GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1902
Mailing Address - Country:US
Mailing Address - Phone:570-575-3195
Mailing Address - Fax:570-347-6665
Practice Address - Street 1:1512 E GIBSON ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1902
Practice Address - Country:US
Practice Address - Phone:570-575-3195
Practice Address - Fax:570-347-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012908251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health