Organization
PHOENIX THERAPEUTIC FOUNDATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMR A ELBESHIR M.A. (PROGRAM DIRECTOR CEO)
(410) 744-9100
Entity
Organization
Contact information
Practice address
5602 BALTIMORE NATIONAL PIKE, SUITE 700, BALTIMORE, MD 21228-1411
(410) 744-9100
(410) 747-0226
Mailing address
5602 BALTIMORE NATIONAL PIKE, SUITE 700, BALTIMORE, MD 21228-1411
(410) 744-9100
(410) 747-0226
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCA149
MD
101YM0800X
Mental Health Counselor
LC1148
MD
104100000X
Social Worker
G08008
MD
1041C0700X
Clinical Social Worker
11349
MD
251S00000X
Community/Behavioral Health Agency
Primary
D0016432
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
403344200
—
MD
Enumeration date
03/01/2007
Last updated
09/27/2012
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