Provider Demographics
NPI:1700528387
Name:BLUE RESILIENCE LLC
Entity Type:Organization
Organization Name:BLUE RESILIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:678-982-2224
Mailing Address - Street 1:2417 FOLEY PARK ST
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2863
Mailing Address - Country:US
Mailing Address - Phone:678-982-2224
Mailing Address - Fax:
Practice Address - Street 1:2417 FOLEY PARK ST
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2863
Practice Address - Country:US
Practice Address - Phone:678-982-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty