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General NPI Number Information
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NPI Number | 1770465403
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Entity Type | Organization
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Legal Business Name | RESILIENT ROOTS COUNSELING, LICENSED CLINICAL SOCIAL WORKER INC
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 490 CHADBOURNE RD STE A118
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City | FAIRFIELD
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State | CA
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Zip | 94534-1827
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Country | US
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Telephone | 707-693-4108
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Fax | 707-266-9969
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Provider Business Mailing Address
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Address Line | 490 CHADBOURNE RD STE A118
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City | FAIRFIELD
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State | CA
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Zip | 94534-1827
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Country | US
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Telephone | 707-693-4108
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Fax | 707-266-9969
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Authorized Official
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Title or Position | DIRECTOR/THERAPIST
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Name | STEPHANIE NICOLE WARD
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Credential | LCSW
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Telephone | 707-337-5032
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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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