Provider Demographics
NPI:1952148298
Name:PHOENIX COUNSELING: BEAUTY FROM ASHES LLC
Entity type:Organization
Organization Name:PHOENIX COUNSELING: BEAUTY FROM ASHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD LMHC BC-TMH NCC
Authorized Official - Phone:772-559-9797
Mailing Address - Street 1:1551 US HIGHWAY 1 # 1141
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5735
Mailing Address - Country:US
Mailing Address - Phone:772-448-7218
Mailing Address - Fax:
Practice Address - Street 1:2366 17TH AVE SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-8052
Practice Address - Country:US
Practice Address - Phone:860-753-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX COUNSELING: BEAUTY FROM ASHES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty