Healthcare Provider Details

I. General information

NPI: 1457264319
Provider Name (Legal Business Name): ROOT & RESTORE THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3769 TIBBETTS ST STE I-2
RIVERSIDE CA
92506-2638
US

IV. Provider business mailing address

3769 TIBBETTS ST STE I-2
RIVERSIDE CA
92506-2638
US

V. Phone/Fax

Practice location:
  • Phone: 949-293-1001
  • Fax:
Mailing address:
  • Phone: 949-293-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KRISTA MARIE CAMPBELL
Title or Position: OWNER
Credential: LCSW
Phone: 949-293-1001