Organization
PHOENIX COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN P OLIVER MS (CEO)
(704) 491-0829
Entity
Organization
Contact information
Practice address
609 E CENTER AVE, MOORESVILLE, NC 28115-2547
(704) 884-2060
(704) 854-4860
Mailing address
631 BRAWLEY SCHOOL RD, STE 300, PMB 302, MOORESVILLE, NC 28117-6204
(704) 360-4531
(704) 360-2544
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301469
—
NC
Enumeration date
04/12/2016
Last updated
04/12/2016
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