MEDICARE: ROOTED & RESTORED COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336768688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED & RESTORED COUNSELING, LLC

Provider Business Mailing Address
First Line	:	230 E TOWN ST STE 210
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-4657
Country	:	US
Telephone Number	:	614-412-1002
Fax Number	:	614-358-9792

Provider Business Practice Location Address
First Line	:	230 E TOWN ST STE 210
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-4657
Country	:	US
Telephone Number	:	614-412-1002
Fax Number	:	614-358-9792

Authorized Official
Title or Position	:	OWNER
Name	:	REBECCA MARTIN
Credential	:
Telephone Number	:	614-721-5920

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	08/24/2022

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