Provider Demographics
NPI:1467003079
Name:PHASES OF HEALING, COUNSELING AND THERAPY LLC
Entity Type:Organization
Organization Name:PHASES OF HEALING, COUNSELING AND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FUSCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-347-0843
Mailing Address - Street 1:4435 COASTAL HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1304
Mailing Address - Country:US
Mailing Address - Phone:904-347-0843
Mailing Address - Fax:
Practice Address - Street 1:290 PASEO REYES DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8462
Practice Address - Country:US
Practice Address - Phone:904-347-0843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)