Provider Demographics
NPI:1902614373
Name:PHOENIX RISING THERAPY PLLC
Entity type:Organization
Organization Name:PHOENIX RISING THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HRIT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-497-4289
Mailing Address - Street 1:122 SPRING LEAF LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-8830
Mailing Address - Country:US
Mailing Address - Phone:734-497-4289
Mailing Address - Fax:
Practice Address - Street 1:1320 N CAMPBELL RD STE 9
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1555
Practice Address - Country:US
Practice Address - Phone:248-241-8635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)