# PHOENIX SOCIAL WORK CENTER, INC.

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

## Provider details

- **NPI number:** 1518700772
- **Authorized official:** MR. JOHN W BLANKS III (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (260) 424-0411

## Contact information

- **Practice address:** 2200 LAKE AVE STE 240, FORT WAYNE, IN 46805-5397
- **Practice address phone:** (260) 424-0411
- **Practice address fax:** (260) 424-3530
- **Mailing address:** 2200 LAKE AVE STE 240, FORT WAYNE, IN 46805-5397
- **Mailing address phone:** (260) 424-0411
- **Mailing address fax:** (260) 424-3530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 06/17/2024
- **Last updated:** 06/17/2024