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Organization
PREMIUM BEHAVIOR CLINIC, LLC
Active
Organization
PREMIUM BEHAVIOR CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DROCELLE WILSON (CEO)
(480) 258-8703
Entity
Organization
Contact information
Practice address
5251 W CAMPBELL AVE STE 203, PHOENIX, AZ 85031-1719
(602) 486-4328
Mailing address
5251 W CAMPBELL AVE STE 203, PHOENIX, AZ 85031-1719
(480) 258-8703
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
10/31/2023
Last updated
02/02/2026
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