Healthcare Provider Details

I. General information

NPI: 1770411134
Provider Name (Legal Business Name): ROOTED IN REAL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 TOMOKA DR
BETHLEHEM GA
30620-4762
US

IV. Provider business mailing address

8735 DUNWOODY PL STE R
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 678-370-7770
  • Fax:
Mailing address:
  • Phone: 678-370-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: D'ANGELA MARK
Title or Position: FOUNDER/CLINICIAN
Credential: LMFT
Phone: 678-370-7770