Provider Demographics
NPI:1285257535
Name:PHAITH COACHING & COUNSELING, LLC
Entity type:Organization
Organization Name:PHAITH COACHING & COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-323-6801
Mailing Address - Street 1:8106 SIERRA OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-3902
Mailing Address - Country:US
Mailing Address - Phone:904-323-6801
Mailing Address - Fax:904-328-1626
Practice Address - Street 1:4940 EMERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4963
Practice Address - Country:US
Practice Address - Phone:904-323-6801
Practice Address - Fax:904-328-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1376817551OtherPERSONAL NPI