Healthcare Provider Details

I. General information

NPI: 1699648519
Provider Name (Legal Business Name): RESILIENT WELLENSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 STATE ROUTE 306 STE 310
WILLOUGHBY OH
44094-9248
US

IV. Provider business mailing address

7700 BRONCO CT
MENTOR OH
44060-7807
US

V. Phone/Fax

Practice location:
  • Phone: 216-284-0463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: YIANNOULA MAVROIDIS
Title or Position: OWNER
Credential: LPCC-S
Phone: 440-223-2405