NPIMap

Organization Active NPI

Phoenix Counseling Center

  • Clinical Social Worker
  • Gastonia, NC
National Provider Identifier
1598074841
Registry record updated Apr 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
P004885 Issued in NC
Legal business name
PHOENIX COUNSELING CENTER
Practice address
2505 Court Dr
Gastonia, NC 28054-2140
Phone
(704) 842-6333
Fax
(704) 854-4860
NPI assigned
Oct 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2011

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

Authorized official

Name
Mrs. Jessie Holbrook Green, MSW, LCSW
Title
Clinician
Phone
(704) 842-6333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X P004885 NC Primary

Addresses

Primary practice location

2505 Court Dr
Gastonia, NC 28054-2140

Mailing address

2505 Court Dr
Gastonia, NC 28054-2140
Phone (704) 842-6333

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Counseling Center9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1598074841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 COURT DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542140",
            "telephone_number": "704-842-6333",
            "fax_number": "704-854-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 COURT DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542140",
            "telephone_number": "704-842-6333",
            "fax_number": "704-854-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-05",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_middle_name": "HOLBROOK",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "704-842-6333",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P004885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; 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.