| Phoenix Counseling & Trauma Treatment Center, Llc | |
|
727 E Landis Ave Vineland NJ 08360-8001 | |
| (856) 300-7770 | |
| Not Available |
| Full Name | Phoenix Counseling & Trauma Treatment Center, Llc |
|---|---|
| Speciality | Counselor |
| Location | 727 E Landis Ave, Vineland, New Jersey |
| Authorized Official Name and Position | Willie Mae Kent (OWNER/DIRECTOR) |
| Authorized Official Contact | 8563007770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Counseling & Trauma Treatment Center, Llc 4601 Ascher Rd Vineland NJ 08361-7601 Ph: (856) 300-7770 | Phoenix Counseling & Trauma Treatment Center, Llc 727 E Landis Ave Vineland NJ 08360-8001 Ph: (856) 300-7770 |
| NPI Number | 1780222976 |
|---|---|
| Provider Enumeration Date | 12/18/2019 |
| Last Update Date | 12/18/2019 |
| Certification Date | 12/18/2019 |
| Medicare PECOS PAC ID | 9335577220 |
|---|---|
| Medicare Enrollment ID | O20200306000571 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780222976 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Willie M Kent |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144877291 PECOS PAC ID: 3274580865 Enrollment ID: I20050406000106 |
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