Provider Demographics
NPI:1801309141
Name:PHOENIX COUNSELING CENTER LLC
Entity type:Organization
Organization Name:PHOENIX COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL CLINICAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:SHAINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPCC
Authorized Official - Phone:440-732-5252
Mailing Address - Street 1:33480 LIBERTY PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2670
Mailing Address - Country:US
Mailing Address - Phone:440-732-5252
Mailing Address - Fax:440-202-6252
Practice Address - Street 1:33480 LIBERTY PKWY
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2670
Practice Address - Country:US
Practice Address - Phone:440-732-5252
Practice Address - Fax:440-202-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty