Healthcare Provider Details

I. General information

NPI: 1992476758
Provider Name (Legal Business Name): CENTER OF RESILIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 ELMWOOD DR
OLDSMAR FL
34677
US

IV. Provider business mailing address

3905 TAMPA RD UNIT 1665
OLDSMAR FL
34677
US

V. Phone/Fax

Practice location:
  • Phone: 727-699-1900
  • Fax:
Mailing address:
  • Phone: 727-699-1900
  • Fax: 727-699-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE C PROCH
Title or Position: MGR
Credential: LMHC
Phone: 727-699-1900