| Phoenix Rising Psychotherapy, Llc | |
|
3045 Rivermont Way Roswell GA 30076-2981 | |
| (678) 389-5327 | |
| Not Available |
| Full Name | Phoenix Rising Psychotherapy, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3045 Rivermont Way, Roswell, Georgia |
| Authorized Official Name and Position | Kathryn Baugus Kopp (OWNER) |
| Authorized Official Contact | 6783895327 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Psychotherapy, Llc 1000 Peachtree Industrial Blvd Ste 6144 Suwanee GA 30024-6737 Ph: (678) 389-5327 | Phoenix Rising Psychotherapy, Llc 3045 Rivermont Way Roswell GA 30076-2981 Ph: (678) 389-5327 |
| NPI Number | 1790536167 |
|---|---|
| Provider Enumeration Date | 04/01/2024 |
| Last Update Date | 06/24/2024 |
| Certification Date | 06/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790536167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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