| Resilient Driven Life, Llc | |
|
602 Adeline St # B2 Hattiesburg MS 39401-3802 | |
| (601) 408-0448 | |
| Not Available |
| Full Name | Resilient Driven Life, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 602 Adeline St # B2, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Tiffiney R Hill (OWNER) |
| Authorized Official Contact | 6014080448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Resilient Driven Life, Llc 76 Lakeland Cir Petal MS 39465-8716 Ph: (601) 408-0448 | Resilient Driven Life, Llc 602 Adeline St # B2 Hattiesburg MS 39401-3802 Ph: (601) 408-0448 |
| NPI Number | 1649919614 |
|---|---|
| Provider Enumeration Date | 05/31/2022 |
| Last Update Date | 05/31/2022 |
| Certification Date | 05/31/2022 |
| Medicare PECOS PAC ID | 3072994045 |
|---|---|
| Medicare Enrollment ID | O20220721003277 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649919614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tiffiney R Hill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225408115 PECOS PAC ID: 9335445402 Enrollment ID: I20160316000554 |
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