Provider Demographics
NPI:1417539412
Name:FOSTERING RESILIENCE LLC
Entity Type:Organization
Organization Name:FOSTERING RESILIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LEVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-293-7093
Mailing Address - Street 1:4114 MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1086
Mailing Address - Country:US
Mailing Address - Phone:903-293-7093
Mailing Address - Fax:903-792-2235
Practice Address - Street 1:1826 HIGHWAY 79 S # THS
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-9198
Practice Address - Country:US
Practice Address - Phone:870-299-3683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty