Phoenix Rising Counseling Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

CSW005912 Issued in GA

Legal business name

PHOENIX RISING COUNSELING SERVICES, LLC

Practice address

200 Colser Dr
Covington, GA 30016-0991

Phone

(678) 824-2010

Fax

(888) 705-0482

NPI assigned

Mar 15, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Aundretta Mykel Wood, LCSWNPI 1568904365

Title

Owner/Therapist

Phone

(678) 824-2010

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aundretta Wood, LCSW

  • Clinical Social Worker
  • Covington, GA
  • NPI 1568904365
  NPD Authorized official
• Patrick Wood, LPC

  • Professional Counselor
  • Conyers, GA
  • NPI 1427434141
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489536000000",
    "number": "1083155667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "863 FLAT SHOALS RD SE",
            "address_2": "SUITE C #149",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300946633",
            "telephone_number": "678-824-2010",
            "fax_number": "888-705-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 COLSER DR",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300160991",
            "telephone_number": "678-824-2010",
            "fax_number": "888-705-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RISING COUNSELING SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-15",
        "last_updated": "2017-03-15",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "AUNDRETTA",
        "authorized_official_middle_name": "MYKEL",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "678-824-2010",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "CSW005912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.