Provider Demographics
NPI:1104848696
Name:ARP/PHOENIX OF BURKE
Entity type:Organization
Organization Name:ARP/PHOENIX OF BURKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-254-2700
Mailing Address - Street 1:1001 EAST UNION STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655
Mailing Address - Country:US
Mailing Address - Phone:828-438-6226
Mailing Address - Fax:828-438-6225
Practice Address - Street 1:31 COLLEGE PLACE
Practice Address - Street 2:B210
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-254-2700
Practice Address - Fax:828-254-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL012101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005261Medicaid
NC6005261Medicaid