# PHOENIX COUNSELING AND SUPPORT SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285148874
- **Authorized official:** MISS JESSICA LEIGH HALSTEAD MSW, LGSW (DIRECTOR)
- **Authorized official phone:** (304) 806-2273

## Contact information

- **Practice address:** 4855 MACCORKLE AVE SW STE 200, SOUTH CHARLESTON, WV 25309-1331
- **Practice address phone:** (304) 806-2273
- **Mailing address:** 4855 MACCORKLE AVE SW STE 200, SOUTH CHARLESTON, WV 25309-1331
- **Mailing address phone:** (304) 806-2273

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 16-121 | WV | Yes |
| 104100000X | Social Worker | BP00942576 | WV | — |

## Other

- **Enumeration date:** 11/20/2017
- **Last updated:** 11/20/2017