Healthcare Provider Details

I. General information

NPI: 1619859410
Provider Name (Legal Business Name): ROOTS & WINGS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W CHERRY AVE APT A
POST FALLS ID
83854-5103
US

IV. Provider business mailing address

317 W CHERRY AVE APT A
POST FALLS ID
83854-5103
US

V. Phone/Fax

Practice location:
  • Phone: 208-403-0039
  • Fax:
Mailing address:
  • Phone: 208-403-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINA DAWN COLISTRO
Title or Position: OWNER
Credential: LPC
Phone: 509-863-3510