Organization
PHOENIX FIRE ABA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FLEUR WHITEHEAD (ADMIN SUPERVISOR)
(931) 572-7402
Entity
Organization
Contact information
Practice address
456 POND APPLE RD UNIT 37, CLARKSVILLE, TN 37043-5357
(301) 752-6997
(931) 218-2075
Mailing address
456 POND APPLE RD UNIT 37, CLARKSVILLE, TN 37043-5357
(301) 752-6997
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q052735
—
TN
Enumeration date
11/17/2022
Last updated
11/17/2022
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