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General NPI Number Information
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NPI Number | 1508842923
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Entity Type | Organization
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Legal Business Name | LEADERSHIP AND RESILIENCE CONSULTANTS, PC
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Dates
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Enumeration Date | 12/17/2005
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 200 FOREST RIDGE DR
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City | FORT MILL
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State | SC
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Zip | 29715-6418
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Country | US
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Telephone | 803-543-7617
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Fax | 800-858-2194
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Provider Business Mailing Address
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Address Line | 15105D JOHN J DELANEY DR STE 192
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City | CHARLOTTE
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State | NC
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Zip | 28277-2741
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Country | US
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Telephone | 704-769-0660
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Fax | 800-858-2194
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. KIMBERLY LANNETTE WILSON
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Credential | LMFT
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Telephone | 704-769-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT000954G
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License Number State | GA
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