| Phoenix Recovery, Llc | |
|
4270 Main St Ste 200 Bridgeport CT 06606-2306 | |
| (203) 243-6170 | |
| Not Available |
| Full Name | Phoenix Recovery, Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 4270 Main St Ste 200, Bridgeport, Connecticut |
| Authorized Official Name and Position | Amond Kenyutta Tillman (SUBSTANCE ABUSE THERAPIST) |
| Authorized Official Contact | 2032436170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Recovery, Llc 14 Marie Dr Apt 12 Seymour CT 06483-3665 Ph: (203) 243-6170 | Phoenix Recovery, Llc 4270 Main St Ste 200 Bridgeport CT 06606-2306 Ph: (203) 243-6170 |
| NPI Number | 1861053183 |
|---|---|
| Provider Enumeration Date | 06/26/2019 |
| Last Update Date | 06/26/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861053183 | NPI | - | NPPES |
| 008087099 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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