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General NPI Number Information
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NPI Number | 1427440320
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Entity Type | Organization
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Legal Business Name | RESILIENCE COMMUNITY SUPPORT SERVICES
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 1612 MARION ST. SUITE 328A
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City | COLUMBIA
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State | SC
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Zip | 29201
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Country | US
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Telephone | 704-497-6131
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Fax | 704-303-9793
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Provider Business Mailing Address
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Address Line | 1612 MARION ST SUITE 328A
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City | COLUMBIA
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State | SC
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Zip | 29201-2939
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Country | US
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Telephone | 704-497-6131
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Fax | 704-303-9793
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Authorized Official
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Title or Position | CEO
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Name | DENISE PORTER
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Credential | LPN
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Telephone | 704-497-6131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | A10380
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License Number State | NC
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