Provider Demographics
NPI:1215698915
Name:PHOENIX HEALING GROUP
Entity type:Organization
Organization Name:PHOENIX HEALING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LASHAWN
Authorized Official - Middle Name:JANELL
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH
Authorized Official - Phone:610-761-2129
Mailing Address - Street 1:607 HELMSDALE CIR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3830
Mailing Address - Country:US
Mailing Address - Phone:610-761-2129
Mailing Address - Fax:
Practice Address - Street 1:10 CORPORATE CIR STE 201
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2418
Practice Address - Country:US
Practice Address - Phone:610-761-2129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty