Provider Demographics
NPI:1598363780
Name:PHOENIX PARTNERS NC
Entity Type:Organization
Organization Name:PHOENIX PARTNERS NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, LCAS
Authorized Official - Phone:919-275-2574
Mailing Address - Street 1:7621 PURFOY RD STE 105B
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-6985
Mailing Address - Country:US
Mailing Address - Phone:919-275-2574
Mailing Address - Fax:
Practice Address - Street 1:7621 PURFOY RD STE 105B
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-6985
Practice Address - Country:US
Practice Address - Phone:919-275-2574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty