Provider Demographics
NPI:1326774464
Name:RESILIENCE TRAUMA THERAPY LLC
Entity Type:Organization
Organization Name:RESILIENCE TRAUMA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:616-566-7194
Mailing Address - Street 1:1117 22ND ST S STE 207
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2813
Mailing Address - Country:US
Mailing Address - Phone:205-922-3429
Mailing Address - Fax:
Practice Address - Street 1:1117 22ND ST S STE 207
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2813
Practice Address - Country:US
Practice Address - Phone:205-922-3429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty