Provider Demographics
NPI:1205407079
Name:PHOENIX RISING THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:PHOENIX RISING THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-725-1188
Mailing Address - Street 1:100 E PENNSYLVANIA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-0700
Mailing Address - Country:US
Mailing Address - Phone:410-725-1188
Mailing Address - Fax:
Practice Address - Street 1:100 E PENNSYLVANIA AVE STE 204
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-0700
Practice Address - Country:US
Practice Address - Phone:410-725-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty