Healthcare Provider Details

I. General information

NPI: 1649850314
Provider Name (Legal Business Name): RADICAL RESILIENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-3959
US

IV. Provider business mailing address

444 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-3959
US

V. Phone/Fax

Practice location:
  • Phone: 312-625-6330
  • Fax:
Mailing address:
  • Phone: 312-625-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICKECIA ALDER
Title or Position: FOUNDER
Credential:
Phone: 312-625-6330