=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710431150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESOLUTIONS COUNSELING & CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2016
-----------------------------------------------------
Last Update Date | 11/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 331 E MAIN ST
-----------------------------------------------------
City | ROCK HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29730-5383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-517-2122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4443
-----------------------------------------------------
City | ROCK HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29732-6443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-517-2122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LISA J FOWLER
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 803-517-2122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | C004973
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 4886
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------