Provider Demographics
NPI:1073292009
Name:RESILIENCE COUNSELING LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:RESILIENCE COUNSELING LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-327-9317
Mailing Address - Street 1:11956 BERNARDO PLAZA DR # 313
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2538
Mailing Address - Country:US
Mailing Address - Phone:619-327-9317
Mailing Address - Fax:
Practice Address - Street 1:12396 WORLD TRADE DR STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3789
Practice Address - Country:US
Practice Address - Phone:619-327-9317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty