Provider Demographics
NPI:1508842923
Name:LEADERSHIP AND RESILIENCE CONSULTANTS, PC
Entity Type:Organization
Organization Name:LEADERSHIP AND RESILIENCE CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LANNETTE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:704-769-0660
Mailing Address - Street 1:15105D JOHN J DELANEY DR STE 192
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2741
Mailing Address - Country:US
Mailing Address - Phone:704-769-0660
Mailing Address - Fax:800-858-2194
Practice Address - Street 1:200 FOREST RIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-6418
Practice Address - Country:US
Practice Address - Phone:803-543-7617
Practice Address - Fax:800-858-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-17
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000954G106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty