Provider Demographics
NPI:1962163444
Name:THE RESILIENCY COLLABORATIVE
Entity type:Organization
Organization Name:THE RESILIENCY COLLABORATIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VOLUNTEER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKARD COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-504-1698
Mailing Address - Street 1:871 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1499
Mailing Address - Country:US
Mailing Address - Phone:919-504-1698
Mailing Address - Fax:
Practice Address - Street 1:871 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1499
Practice Address - Country:US
Practice Address - Phone:919-504-1698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)