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General NPI Number Information
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NPI Number | 1932680600
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Entity Type | Organization
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Legal Business Name | SEAT OF RESILIENCE CONSULTING AND COUNSELING LLC
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 386 E CYPRESS ST STE 1
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City | LUDOWICI
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State | GA
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Zip | 31316-3118
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Country | US
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Telephone | 912-545-2570
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Fax | 912-210-5433
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Provider Business Mailing Address
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Address Line | PO BOX 918
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City | LUDOWICI
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State | GA
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Zip | 31316-0918
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MRS. TAMARA DANIELLE BOGAN
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Credential | LPC
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Telephone | 912-545-2570
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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 | LPC010308
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License Number State | GA
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