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General NPI Number Information
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NPI Number | 1679457477
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Entity Type | Organization
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Legal Business Name | RESILIENT ROOTS CONSULTING, LLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 2144 LAKESHORE DR APT 12B
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City | RIDGELAND
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State | MS
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Zip | 39157-1029
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Country | US
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Telephone | 973-652-0978
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Fax |
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Provider Business Mailing Address
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Address Line | 2144 LAKESHORE DR APT 12B
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City | RIDGELAND
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State | MS
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Zip | 39157-1029
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Country | US
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Telephone | 973-652-0978
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | INA SIMPSON
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Credential | PHD
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Telephone | 973-652-0978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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