MEDICARE: COMMUNITY RESILIENCY INITIATIVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	103T00000X	Psychologist
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1265270169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY RESILIENCY INITIATIVE

Provider Business Mailing Address
First Line	:	4518 BEECH RD STE 230
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6735
Country	:	US
Telephone Number	:	202-643-3592
Fax Number	:

Provider Business Practice Location Address
First Line	:	4518 BEECH RD STE 230
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6735
Country	:	US
Telephone Number	:	202-643-3592
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	DR. LAKEITH BARRY SUTTON
Credential	:	DSW, LCSW
Telephone Number	:	202-643-3592

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	07/16/2024

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