Healthcare Provider Details

I. General information

NPI: 1245724707
Provider Name (Legal Business Name): RESILIENCE COUNSELING & SOCIAL SKILLS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6524 WOODLAKE VILLAGE CIR
MIDLOTHIAN VA
23112-2200
US

IV. Provider business mailing address

6524 WOODLAKE VILLAGE CIR
MIDLOTHIAN VA
23112-2200
US

V. Phone/Fax

Practice location:
  • Phone: 540-699-0226
  • Fax: 540-699-0224
Mailing address:
  • Phone: 540-699-0226
  • Fax: 540-699-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. KARL GEORGE MEMMER
Title or Position: OWNER/LPC
Credential: MS,LPC
Phone: 540-699-0226