Provider Demographics
NPI:1366854911
Name:PHOENIX COUNSELING CENTER
Entity Type:Organization
Organization Name:PHOENIX COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:704-360-4531
Mailing Address - Street 1:631 BRAWLEY SCHOOL RD
Mailing Address - Street 2:SUITE 200B, PMB 301
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6204
Mailing Address - Country:US
Mailing Address - Phone:704-360-4531
Mailing Address - Fax:704-360-2544
Practice Address - Street 1:350 E PARKER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5155
Practice Address - Country:US
Practice Address - Phone:704-360-4531
Practice Address - Fax:704-360-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health