Organization
PHOENIX RISING CENTERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADRONE B. PHOENIX LICSW (OWNER)
(401) 441-5834
Entity
Organization
Contact information
Practice address
313 MAIN ST UNIT G, WAKEFIELD, RI 02879-7405
(401) 441-5834
(401) 210-8248
Mailing address
1 RICHMOND SQ STE 350W, PROVIDENCE, RI 02906-5165
(401) 441-5834
(401) 210-8248
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
07/02/2022
Last updated
02/26/2025
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