Provider Demographics
NPI:1811588932
Name:PHOENIX RISING COUNSELING AND CONSULTING, LLC.
Entity type:Organization
Organization Name:PHOENIX RISING COUNSELING AND CONSULTING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-581-9299
Mailing Address - Street 1:18039 RED MULBERRY RD
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2967
Mailing Address - Country:US
Mailing Address - Phone:571-241-7485
Mailing Address - Fax:
Practice Address - Street 1:8609 WESTWOOD CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:TYSONS CORNER
Practice Address - State:VA
Practice Address - Zip Code:22182-7525
Practice Address - Country:US
Practice Address - Phone:571-581-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699208165Medicaid