Provider Demographics
NPI:1871321661
Name:PHOENIX WELLNESS LLC
Entity type:Organization
Organization Name:PHOENIX WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CICELY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CALVARESI-HOLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:610-790-4140
Mailing Address - Street 1:1209 WHITFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1138
Mailing Address - Country:US
Mailing Address - Phone:610-790-4140
Mailing Address - Fax:
Practice Address - Street 1:2 WOODLAND RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1999
Practice Address - Country:US
Practice Address - Phone:484-222-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)