Provider Demographics
NPI:1720549645
Name:PHOENIX ALIGHTING THERAPEUTIC HEALING SERVICES
Entity Type:Organization
Organization Name:PHOENIX ALIGHTING THERAPEUTIC HEALING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-501-9362
Mailing Address - Street 1:100 E PENNSYLVANIA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-0700
Mailing Address - Country:US
Mailing Address - Phone:443-501-9362
Mailing Address - Fax:
Practice Address - Street 1:100 E PENNSYLVANIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:443-501-9362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness