Provider Demographics
NPI:1639910003
Name:THE PHOENIX COUNSELING AND RECOVERY PROJECT LLC
Entity type:Organization
Organization Name:THE PHOENIX COUNSELING AND RECOVERY PROJECT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-286-0000
Mailing Address - Street 1:4121 SW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5714
Mailing Address - Country:US
Mailing Address - Phone:239-286-0000
Mailing Address - Fax:
Practice Address - Street 1:3441 COLONIAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1121
Practice Address - Country:US
Practice Address - Phone:239-268-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-01
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty