Provider Demographics
NPI:1528627544
Name:RESILIENCE COMMUNITY COUNSELING LLC
Entity type:Organization
Organization Name:RESILIENCE COMMUNITY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAIN-BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC, NCC, LBS
Authorized Official - Phone:215-399-2098
Mailing Address - Street 1:PO BOX 7164
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-0164
Mailing Address - Country:US
Mailing Address - Phone:215-399-2098
Mailing Address - Fax:
Practice Address - Street 1:7910 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2627
Practice Address - Country:US
Practice Address - Phone:215-399-2098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health