Organization
PHOENIX PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIAMOND CALLOWAY (EXECUTIVE DIRECTOR)
(502) 656-9261
Entity
Organization
Contact information
Practice address
2012 W CHESTNUT ST, LOUISVILLE, KY 40203-1542
(502) 656-9261
Mailing address
2012 W CHESTNUT ST, LOUISVILLE, KY 40203-1542
(502) 656-9261
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
08/29/2023
Last updated
05/07/2024
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