Provider Demographics
NPI:1447861174
Name:PHAZE COUNSELING SERVICES INC
Entity type:Organization
Organization Name:PHAZE COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNTEL
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:GLADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-622-8755
Mailing Address - Street 1:4425 FITCH AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3927
Mailing Address - Country:US
Mailing Address - Phone:410-870-2125
Mailing Address - Fax:
Practice Address - Street 1:4425 FITCH AVE STE 118
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3927
Practice Address - Country:US
Practice Address - Phone:410-870-2125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)