MEDICARE: RESURGENCE COUNSELING 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1760015408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURGENCE COUNSELING LLC

Provider Business Mailing Address
First Line	:	2686 CHAPMAN DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4914
Country	:	US
Telephone Number	:
Fax Number	:	850-740-3179

Provider Business Practice Location Address
First Line	:	272 FOREST PARK CIRCLE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-0000
Country	:	US
Telephone Number	:	850-247-9559
Fax Number	:	850-248-2469

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PATRICIA ALDAY
Credential	:	LMHC
Telephone Number	:	850-247-9559

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	09/25/2024

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