Provider Demographics
NPI:1124754122
Name:PHOENIX COUNSELING COLLABORATIVE LLC
Entity type:Organization
Organization Name:PHOENIX COUNSELING COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS-ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCAS, CSI
Authorized Official - Phone:336-414-7794
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-0823
Mailing Address - Country:US
Mailing Address - Phone:336-443-4076
Mailing Address - Fax:336-443-4126
Practice Address - Street 1:306 N WHITE ST
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8938
Practice Address - Country:US
Practice Address - Phone:336-443-4076
Practice Address - Fax:336-443-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty