MEDICARE: SANKOFA RESILIENCE

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	:	1528952827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANKOFA RESILIENCE

Provider Business Mailing Address
First Line	:	3317 WOODROW AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2720
Country	:	US
Telephone Number	:	646-963-1103
Fax Number	:

Provider Business Practice Location Address
First Line	:	3317 WOODROW AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2720
Country	:	US
Telephone Number	:	646-963-1103
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	EBONY MACK
Credential	:	LCSW
Telephone Number	:	646-963-1103

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	06/03/2025

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Directions to “SANKOFA RESILIENCE ” Practice Location

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