Provider Demographics
NPI:1427588557
Name:PHOENIX COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PHOENIX COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-623-2334
Mailing Address - Street 1:139 IRON HORSE DR
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5775
Mailing Address - Country:US
Mailing Address - Phone:404-333-2446
Mailing Address - Fax:
Practice Address - Street 1:646 OLD PHOENIX RD STE I
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5007
Practice Address - Country:US
Practice Address - Phone:706-623-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health