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General NPI Number Information
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NPI Number | 1043917578
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Entity Type | Organization
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Legal Business Name | ELEVATING RESILIENCE COUNSELING LLC
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 1 TIFFANY PT STE G11
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2961
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Country | US
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Telephone | 630-446-0162
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Fax |
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Provider Business Mailing Address
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Address Line | 179 PINTAIL LN
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-5411
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Country | US
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Telephone | 570-220-4919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TABITHA GUILLAUME
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Credential | LCPC
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Telephone | 570-220-4919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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