Phoenix Counseling & Trauma Treatment Center, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

PHOENIX COUNSELING & TRAUMA TREATMENT CENTER, LLC

Practice address

727 E Landis Ave
Vineland, NJ 08360-8001

Phone

(856) 300-7770

NPI assigned

Dec 18, 2019

Organization subpart

No

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

Authorized official

Name

Willie Mae Kent, LCSW

Title

Owner/Director

Phone

(856) 300-7770

Specialties & licenses 1

Addresses

Other names 1

• Phoenix Counseling & Trauma Treatment Center, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

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

• Willie Mae Kent, LCSW

  • Clinical Social Worker
  • Vineland, NJ
  • NPI 1144877291
  Medicare reassignment NPD
• Manouchehr T Shahab, MD

  • Family Medicine Physician
  • Midland Park, NJ
  • NPI 1780697490
  NPD (past)

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

{
    "created_epoch": "1576627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1780222976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 ASCHER RD",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083617601",
            "telephone_number": "856-300-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 E LANDIS AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083608001",
            "telephone_number": "856-300-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX COUNSELING & TRAUMA TREATMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-18",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "KENT",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "856-300-7770",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Counseling & Trauma Treatment Center, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Ann Evaline Phifer, APN-BC
• Raysa Phillips
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• Donna Lee Pickett
• Latia M Pierce, APN

• Mental Health Counselor in Vineland, NJ
• Providers in Vineland, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.