Provider Demographics
NPI:1427440320
Name:RESILIENCE COMMUNITY SUPPORT SERVICES
Entity type:Organization
Organization Name:RESILIENCE COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:704-497-6131
Mailing Address - Street 1:1612 MARION ST
Mailing Address - Street 2:SUITE 328A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2939
Mailing Address - Country:US
Mailing Address - Phone:704-497-6131
Mailing Address - Fax:704-303-9793
Practice Address - Street 1:1612 MARION ST.
Practice Address - Street 2:SUITE 328A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:704-497-6131
Practice Address - Fax:704-303-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10380101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty