Healthcare Provider Details

I. General information

NPI: 1023948239
Provider Name (Legal Business Name): ROOTED GROWTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 SUSSEX DR
FLORENCE KY
41042-2211
US

IV. Provider business mailing address

PO BOX 90
HEBRON KY
41048-0090
US

V. Phone/Fax

Practice location:
  • Phone: 859-414-6471
  • Fax:
Mailing address:
  • Phone: 859-414-6471
  • 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: MARIETTA JUSTICE
Title or Position: OWNER
Credential: LPCC-S
Phone: 859-414-6471