Provider Demographics
NPI:1245068907
Name:AMY'S RISING PHOENIX COUNSELING, PLLC
Entity type:Organization
Organization Name:AMY'S RISING PHOENIX COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:O'HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS
Authorized Official - Phone:336-265-2720
Mailing Address - Street 1:2710 CHADBURY DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6697
Mailing Address - Country:US
Mailing Address - Phone:336-987-4449
Mailing Address - Fax:
Practice Address - Street 1:3225 BATTLEGROUND AVE STE 4
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2636
Practice Address - Country:US
Practice Address - Phone:336-265-2720
Practice Address - Fax:336-265-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health