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General NPI Number Information
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NPI Number | 1992476758
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Entity Type | Organization
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Legal Business Name | CENTER OF RESILIENCE
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 1802 ELMWOOD DR
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City | OLDSMAR
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State | FL
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Zip | 34677
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Country | US
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Telephone | 727-699-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 3905 TAMPA RD UNIT 1665
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City | OLDSMAR
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State | FL
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Zip | 34677
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Country | US
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Telephone | 727-699-1900
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Fax | 727-699-1800
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Authorized Official
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Title or Position | MGR
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Name | DANIELLE C PROCH
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Credential | LMHC
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Telephone | 727-699-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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