Organization
RISEN PHOENIX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAVON MONIQUE DAWSON (OWNER)
(313) 702-2261
Entity
Organization
Contact information
Practice address
15338 VIRGIL ST, DETROIT, MI 48223-1442
(313) 702-2261
Mailing address
15338 VIRGIL ST, DETROIT, MI 48223-1442
(313) 702-2261
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
12/17/2024
Last updated
12/17/2024
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