Provider Demographics
NPI:1972373884
Name:PURPLE PHOENIX COUNSELING
Entity Type:Organization
Organization Name:PURPLE PHOENIX COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:207-385-3685
Mailing Address - Street 1:8362 SIX FORKS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5086
Mailing Address - Country:US
Mailing Address - Phone:207-385-3685
Mailing Address - Fax:984-202-2222
Practice Address - Street 1:8362 SIX FORKS RD STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5086
Practice Address - Country:US
Practice Address - Phone:207-385-3685
Practice Address - Fax:984-202-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty