Provider Demographics
NPI:1013293414
Name:PHOENIX MINISTRIES, INC.
Entity type:Organization
Organization Name:PHOENIX MINISTRIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STRACHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:843-422-9668
Mailing Address - Street 1:127 TRAFALGAR ST SW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3760
Mailing Address - Country:US
Mailing Address - Phone:843-422-9668
Mailing Address - Fax:
Practice Address - Street 1:127 TRAFALGAR ST SW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3760
Practice Address - Country:US
Practice Address - Phone:843-422-9668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRS513802D106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty