| Phoenix Risings Counseling Center Llc | |
|
50 Union Ave Ste 804b Irvington NJ 07111-5221 | |
| (770) 568-0619 | |
| (973) 629-1741 |
| Full Name | Phoenix Risings Counseling Center Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 50 Union Ave Ste 804b, Irvington, New Jersey |
| Authorized Official Name and Position | Lynne Chantel Holley (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9733930312 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Risings Counseling Center Llc Po Box 358 South Orange NJ 07079-0358 Ph: (770) 568-0619 | Phoenix Risings Counseling Center Llc 50 Union Ave Ste 804b Irvington NJ 07111-5221 Ph: (770) 568-0619 |
| NPI Number | 1417479056 |
|---|---|
| Provider Enumeration Date | 07/14/2017 |
| Last Update Date | 08/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417479056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 37LC00259900 (New Jersey) | Secondary |
| 1041C0700X | Social Worker - Clinical | 44SC05717900 (New Jersey) | Primary |
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