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General NPI Number Information
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NPI Number | 1962163444
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Entity Type | Organization
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Legal Business Name | THE RESILIENCY COLLABORATIVE
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 871 WASHINGTON ST
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City | RALEIGH
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State | NC
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Zip | 27605-1499
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Country | US
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Telephone | 919-504-1698
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Fax |
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Provider Business Mailing Address
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Address Line | 871 WASHINGTON ST
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City | RALEIGH
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State | NC
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Zip | 27605-1499
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Country | US
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Telephone | 919-504-1698
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Fax |
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Authorized Official
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Title or Position | VOLUNTEER DIRECTOR
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Name | TAMMY BLACKARD COOK
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Credential | LCSW
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Telephone | 919-504-1698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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