Healthcare Provider Details

I. General information

NPI: 1023652484
Provider Name (Legal Business Name): HEALING ROOTS THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6218 GEORGIA AVE NW UNIT 1031
WASHINGTON DC
20011-5125
US

IV. Provider business mailing address

6218 GEORGIA AVE NW UNIT 1031
WASHINGTON DC
20011-5125
US

V. Phone/Fax

Practice location:
  • Phone: 504-236-2982
  • Fax: 833-243-7203
Mailing address:
  • Phone: 504-236-2982
  • Fax: 833-243-7203

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: AALIYAH MUHAMMAD
Title or Position: OWNER / PROVIDER
Credential:
Phone: 504-236-2982