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Organization
PHOENIX PSYCHOLOGICAL & COUNSELING ASSOC INC
Active
Organization
PHOENIX PSYCHOLOGICAL & COUNSELING ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES MCCLURE GREEN (OWNER)
(304) 622-6404
Entity
Organization
Contact information
Practice address
RT 20, QUIET DELL, WV 26408
(304) 622-6404
(304) 622-6404
Mailing address
4579 BUCKHANNON PIKE STE 101, MOUNT CLARE, WV 26408-7176
(304) 622-6404
(304) 622-6404
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
WV
103T00000X
Psychologist
—
WV
1041C0700X
Clinical Social Worker
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001710319
BCBS
WV
Enumeration date
09/30/2005
Last updated
07/21/2022
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