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General NPI Number Information
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NPI Number | 1679396899
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Entity Type | Organization
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Legal Business Name | RESILIENT ROOTS COUNSELING LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 231 NORTHERN BLVD STE A
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City | SOUTH ABINGTON TOWNSHIP
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State | PA
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Zip | 18411-9189
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Country | US
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Telephone | 570-880-0079
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Fax |
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Provider Business Mailing Address
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Address Line | 231 NORTHERN BLVD STE A
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City | SOUTH ABINGTON TOWNSHIP
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State | PA
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Zip | 18411-9189
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Country | US
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Telephone | 570-880-0079
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH HOLDEN
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Credential | LCSW
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Telephone | 570-903-0855
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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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