NPIMap

Organization Active NPI

Phoenix Counseling and Support Services

  • Addiction (Substance Use Disorder) Counselor
  • South Charleston, WV
National Provider Identifier
1285148874
Registry record updated Nov 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
16-121 Issued in WV
Legal business name
PHOENIX COUNSELING AND SUPPORT SERVICES
Practice address
4855 Maccorkle Ave SW Ste 200
South Charleston, WV 25309-1331
Phone
(304) 806-2273
NPI assigned
Nov 20, 2017
Last updated
Nov 20, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2017

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

Authorized official

Name
Miss Jessica Leigh Halstead, MSW, LGSWNPI 1821529660
Title
Director
Phone
(304) 806-2273

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 16-121 WV Primary
Social Worker 104100000X BP00942576 WV

Addresses

Primary practice location

4855 Maccorkle Ave SW Ste 200
South Charleston, WV 25309-1331

Mailing address

4855 Maccorkle Ave SW Ste 200
South Charleston, WV 25309-1331
Phone (304) 806-2273

National Provider Directory

National Provider Directory

Locations

4855 Maccorkle Ave SW
Ste 200
South Charleston, WV 25309
Phone (304) 720-4444

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511136000000",
    "number": "1285148874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 MACCORKLE AVE SW STE 200",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091331",
            "telephone_number": "304-806-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 MACCORKLE AVE SW STE 200",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091331",
            "telephone_number": "304-806-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX COUNSELING AND SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-20",
        "last_updated": "2017-11-20",
        "status": "A",
        "authorized_official_last_name": "HALSTEAD",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "304-806-2273",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MSW, LGSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WV",
            "license": "16-121",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WV",
            "license": "BP00942576",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.