Healthcare Provider Details

I. General information

NPI: 1447188792
Provider Name (Legal Business Name): ROOTED OLIVE TREE WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N MAIN ST STE 3D-A
SOUTHINGTON CT
06489-2537
US

IV. Provider business mailing address

30 WHISPERING HOLLOW CT
CHESHIRE CT
06410-3319
US

V. Phone/Fax

Practice location:
  • Phone: 203-535-3385
  • Fax:
Mailing address:
  • Phone: 203-535-3385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KAITLIN JARJURA
Title or Position: CO-OWNER
Credential: LPC
Phone: 203-535-3385