Healthcare Provider Details

I. General information

NPI: 1619560174
Provider Name (Legal Business Name): RESILIENT MINDS TELEPSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 COUNTRY OAKS RD
CHARLOTTE NC
28227-5937
US

IV. Provider business mailing address

8400 COUNTRY OAKS RD
CHARLOTTE NC
28227-5937
US

V. Phone/Fax

Practice location:
  • Phone: 980-875-7263
  • Fax:
Mailing address:
  • Phone: 980-875-7263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: FELICIA JENKINS
Title or Position: PSYCHIATRIC MENTAL HEALTH NURSE
Credential: PMHNP-BC
Phone: 980-875-7263