# PHOENIX WELLNESS LLC

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

## Provider details

- **NPI number:** 1780348789
- **Authorized official:** DAVID N SMITH MD (OWNER)
- **Authorized official phone:** (704) 609-7334

## Contact information

- **Practice address:** 1040 EDGEWATER CORPORATE PKWY STE 106, FORT MILL, SC 29707-4526
- **Practice address phone:** (704) 609-7334
- **Practice address fax:** (855) 655-3374
- **Mailing address:** 1600 CHURCHILL DOWNS DR, WAXHAW, NC 28173-6627
- **Mailing address phone:** (704) 609-7334
- **Mailing address fax:** (855) 655-3374

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 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