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General NPI Number Information
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NPI Number | 1124760863
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Entity Type | Organization
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Legal Business Name | INNATE RESILIENCE PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 408 JONES AVE
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City | HILLSBOROUGH
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State | NC
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Zip | 27278
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Country | US
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Telephone | 919-446-5352
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Fax | 919-808-4334
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Provider Business Mailing Address
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Address Line | 1818 MARTIN LUTHER KING JR BLVD # 331
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City | CHAPEL HILL
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State | NC
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Zip | 27514-7415
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Country | US
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Telephone | 919-446-5352
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Fax | 919-808-4334
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDRA WILLARD
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Credential | LCSW
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Telephone | 919-446-5352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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