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General NPI Number Information
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NPI Number | 1316551104
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Entity Type | Organization
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Legal Business Name | RESILIENT SPIRIT PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 515 CENTERPOINT DR STE 305
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City | MIDDLETOWN
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State | CT
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Zip | 06457-7570
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Country | US
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Telephone | 860-467-0770
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Fax | 860-467-0660
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Provider Business Mailing Address
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Address Line | 515 CENTERPOINT DR STE 305
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City | MIDDLETOWN
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State | CT
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Zip | 06457-7570
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Country | US
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Telephone | 860-965-4954
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL/OWNER
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Name | TRACI HOWLAND
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Credential | LMFT
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Telephone | 860-467-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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