Provider Demographics
NPI:1154621134
Name:PHOENIX COUNSELING CENTER
Entity type:Organization
Organization Name:PHOENIX COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TONCE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCAS-P
Authorized Official - Phone:704-299-3879
Mailing Address - Street 1:6210 ROBUR CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1686
Mailing Address - Country:US
Mailing Address - Phone:704-299-3879
Mailing Address - Fax:
Practice Address - Street 1:2505 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-861-8014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396845004Medicaid
NC8301469Other6005727