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General NPI Number Information
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NPI Number | 1578963468
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Entity Type | Organization
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Legal Business Name | THE RESILIENT LIFE COUNSELING & WELLNESS CENTER
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 2 E ROLLING CROSSROADS STE 157
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City | CATONSVILLE
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State | MD
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Zip | 21228-6213
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Country | US
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Telephone | 443-502-0471
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Fax |
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Provider Business Mailing Address
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Address Line | 2 E ROLLING CROSSROADS STE 157
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City | CATONSVILLE
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State | MD
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Zip | 21228-6213
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Country | US
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Telephone | 443-592-0471
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Fax | 443-276-2800
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Authorized Official
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Title or Position | CEO
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Name | TRACY BRENTON
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Credential | MS, LCPC
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Telephone | 443-502-0471
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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 | LC4717
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License Number State | MD
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