Provider Demographics
NPI:1831473826
Name:PHOENIX RISING COUNSELING & RECOVERY SERVICES
Entity Type:Organization
Organization Name:PHOENIX RISING COUNSELING & RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:315-415-9795
Mailing Address - Street 1:49 OSWEGO ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2448
Mailing Address - Country:US
Mailing Address - Phone:315-415-9795
Mailing Address - Fax:
Practice Address - Street 1:49 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2448
Practice Address - Country:US
Practice Address - Phone:315-415-9795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0705221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty