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General NPI Number Information
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NPI Number | 1689139362
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Entity Type | Organization
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Legal Business Name | RESILIENCY BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 145 GOVENORS SQUARE STE A
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City | FAYETTEVILLE
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State | GA
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Zip | 30269
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Country | US
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Telephone | 770-668-3130
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Fax | 267-295-2834
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Provider Business Mailing Address
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Address Line | PO BOX 302
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City | TURIN
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State | GA
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Zip | 30289-0302
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Country | US
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Telephone | 770-668-3130
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Fax | 267-295-2834
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | CHARLES JOSEPH POPOV
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Credential | LPC
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Telephone | 770-668-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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