Provider Demographics
NPI:1316243975
Name:PHOENIX AND PEARL COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:PHOENIX AND PEARL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, ATR-BC
Authorized Official - Phone:404-901-5889
Mailing Address - Street 1:1708 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2434
Mailing Address - Country:US
Mailing Address - Phone:404-901-5889
Mailing Address - Fax:404-872-0925
Practice Address - Street 1:1708 PEACHTREE ST NW
Practice Address - Street 2:SUITE 505
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2434
Practice Address - Country:US
Practice Address - Phone:404-901-5889
Practice Address - Fax:404-872-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty