Healthcare Provider Details

I. General information

NPI: 1649770363
Provider Name (Legal Business Name): RESILIENCE HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 HUGUENOT RD STE 201
MIDLOTHIAN VA
23113-2438
US

IV. Provider business mailing address

1525 HUGUENOT RD STE 201
MIDLOTHIAN VA
23113-2438
US

V. Phone/Fax

Practice location:
  • Phone: 804-415-4113
  • Fax: 804-414-7580
Mailing address:
  • Phone: 804-415-4113
  • Fax: 804-414-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. COLLIN BEATTY
Title or Position: MANAGER
Credential:
Phone: 713-899-3331