Provider Demographics
NPI:1770465403
Name:RESILIENT ROOTS COUNSELING, LICENSED CLINICAL SOCIAL WORKER INC
Entity type:Organization
Organization Name:RESILIENT ROOTS COUNSELING, LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-337-5032
Mailing Address - Street 1:490 CHADBOURNE RD STE A118
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1827
Mailing Address - Country:US
Mailing Address - Phone:707-693-4108
Mailing Address - Fax:707-266-9969
Practice Address - Street 1:490 CHADBOURNE RD STE A118
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1827
Practice Address - Country:US
Practice Address - Phone:707-693-4108
Practice Address - Fax:707-266-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty