Organization
FENIX COLLECTIVE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA ANNE SUMMERS NCCPSS (CEO)
(704) 231-1079
Entity
Organization
Contact information
Practice address
5222 SPLIT OAK DR, CHARLOTTE, NC 28227-0327
(704) 231-1079
Mailing address
5222 SPLIT OAK DR, CHARLOTTE, NC 28227-0327
(704) 231-1079
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
175T00000X
Peer Specialist
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
05/07/2024
Last updated
05/07/2024
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