Provider Demographics
NPI:1982170346
Name:RESILIENCE PROFESSIONAL COUNSELING, LLC
Entity Type:Organization
Organization Name:RESILIENCE PROFESSIONAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-288-6274
Mailing Address - Street 1:2116 HICKORY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-1758
Mailing Address - Country:US
Mailing Address - Phone:757-288-6274
Mailing Address - Fax:855-421-1800
Practice Address - Street 1:1403 GREENBRIER PKWY STE 150
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0624
Practice Address - Country:US
Practice Address - Phone:757-288-6274
Practice Address - Fax:855-421-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA601258624Medicaid