| Organization Name: | PHOENIX COUNSELINGGROUP AND PLAY THERAPYCENTER, PLLC |
| NPI Number: | 1699123380 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOUGLAS ROBERT MCCRACKEN (CEO) |
| Mailing Address: | 6611 Jefferson St Haymarket |
| State: | VA US |
| Postal Code: | 201694902 |
| Phone Number: | 5712480626 |
| Fax Number: | |
| NPI Enumeration Date: | 06/02/2016 |
| NPI Last Update Date: | 06/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 0701004422 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |