| Phoenix Rising Therapeutic Services | |
|
100 E Pennsylvania Ave Ste 204 Towson MD 21286-0700 | |
| (410) 725-1188 | |
| Not Available |
| Full Name | Phoenix Rising Therapeutic Services |
|---|---|
| Speciality | Counselor |
| Location | 100 E Pennsylvania Ave Ste 204, Towson, Maryland |
| Authorized Official Name and Position | Dionne N Coleman (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4107251188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Therapeutic Services 100 E Pennsylvania Ave Ste 204 Towson MD 21286-0700 Ph: (410) 725-1188 | Phoenix Rising Therapeutic Services 100 E Pennsylvania Ave Ste 204 Towson MD 21286-0700 Ph: (410) 725-1188 |
| NPI Number | 1205407079 |
|---|---|
| Provider Enumeration Date | 07/02/2021 |
| Last Update Date | 07/02/2021 |
| Certification Date | 07/02/2021 |
| Medicare PECOS PAC ID | 5294191623 |
|---|---|
| Medicare Enrollment ID | O20230510000144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205407079 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Dionne Coleman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285141762 PECOS PAC ID: 6103282538 Enrollment ID: I20230510000199 |
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