Provider Demographics
NPI:1548760960
Name:PHOENIX CENTER FOR HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:PHOENIX CENTER FOR HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAKEETRA
Authorized Official - Middle Name:MCCLAINE
Authorized Official - Last Name:JOSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APRN, PMHNP-BC
Authorized Official - Phone:302-298-3818
Mailing Address - Street 1:222 PHILADELPHIA PIKE STE 12
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3166
Mailing Address - Country:US
Mailing Address - Phone:302-543-5321
Mailing Address - Fax:888-801-2676
Practice Address - Street 1:222 PHILADELPHIA PIKE STE 12
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809
Practice Address - Country:US
Practice Address - Phone:302-543-5321
Practice Address - Fax:888-801-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder