Provider Demographics
NPI:1477065415
Name:PHOENIX COUNSELING AND RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:PHOENIX COUNSELING AND RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SARDIE
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:IZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS-A, LCSW-A
Authorized Official - Phone:336-550-4558
Mailing Address - Street 1:405 BATTLEGROUND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2153
Mailing Address - Country:US
Mailing Address - Phone:335-550-4558
Mailing Address - Fax:
Practice Address - Street 1:1102 KINDLEY ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-4213
Practice Address - Country:US
Practice Address - Phone:336-458-7135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22298101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty