Provider Demographics
NPI:1952177362
Name:RESILIENT ROOTS HEALING, PLLC
Entity Type:Organization
Organization Name:RESILIENT ROOTS HEALING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:CAMBRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-798-3873
Mailing Address - Street 1:3503 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8787
Mailing Address - Country:US
Mailing Address - Phone:773-798-3873
Mailing Address - Fax:
Practice Address - Street 1:3503 STONE CREEK DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8787
Practice Address - Country:US
Practice Address - Phone:773-798-3873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty