MEDICARE: RESILIENCE & RESTORE COUNSELING SERVICES, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1366371239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESILIENCE & RESTORE COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	1101 N BERKELEY BLVD # 1026
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-3490
Country	:	US
Telephone Number	:	910-236-2498
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 N BERKELEY BLVD # 1026
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-3490
Country	:	US
Telephone Number	:	910-236-2498
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	FAREIZA BLUNT
Credential	:	LCSW
Telephone Number	:	910-236-2498

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/19/2026

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