MEDICARE: RESILIENT ROOTS PSYCHOTHERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1568325751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESILIENT ROOTS PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	608 GEORGIA AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-2912
Country	:	US
Telephone Number	:	757-289-4415
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 GEORGIA AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-2912
Country	:	US
Telephone Number	:	757-289-4415
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LPC
Name	:	CAITLIN CAVANAUGH
Credential	:	LPC
Telephone Number	:	757-289-4415

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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