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Organization
PHOENIX WELLNESS LLC
Active
Organization
PHOENIX WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID N SMITH MD (OWNER)
(704) 609-7334
Entity
Organization
Contact information
Practice address
1040 EDGEWATER CORPORATE PKWY STE 106, FORT MILL, SC 29707-4526
(704) 609-7334
(855) 655-3374
Mailing address
1600 CHURCHILL DOWNS DR, WAXHAW, NC 28173-6627
(704) 609-7334
(855) 655-3374
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
261QP2400X
Prison Health Clinic/Center
—
NULL
261QV0200X
VA Clinic/Center
—
NULL
Other
Enumeration date
10/26/2021
Last updated
10/26/2021
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