Risen Phoenix LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

RISEN PHOENIX LLC

Practice address

15338 Virgil St
Detroit, MI 48223-1442

Phone

(313) 702-2261

NPI assigned

Dec 17, 2024

Organization subpart

No

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

Authorized official

Name

Ravon Monique Dawson

Title

Owner

Phone

(313) 702-2261

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1734393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1922815422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15338 VIRGIL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482231442",
            "telephone_number": "313-702-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15338 VIRGIL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482231442",
            "telephone_number": "313-702-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RISEN PHOENIX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-17",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "RAVON",
        "authorized_official_middle_name": "MONIQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-702-2261"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Detroit, MI
• Providers in Detroit, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.