Provider Demographics
NPI:1104109354
Name:PHOENIX, DAYO
Entity type:Individual
Prefix:
First Name:DAYO
Middle Name:
Last Name:PHOENIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 DARDEN RD
Mailing Address - Street 2:UNIT K
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3117 DARDEN RD
Practice Address - Street 2:UNIT K
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-6758
Practice Address - Country:US
Practice Address - Phone:336-772-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0057061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical