Healthcare Provider Details

I. General information

NPI: 1326663667
Provider Name (Legal Business Name): ROOTED COUNSELING AND CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 MAIN ST STE A272
ZACHARY LA
70791-4083
US

IV. Provider business mailing address

2703 MARCH ST
ZACHARY LA
70791-2830
US

V. Phone/Fax

Practice location:
  • Phone: 225-407-3611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CARRIE S. DAVIDSON
Title or Position: MANAGER
Credential: LPC 6503
Phone: 225-888-1752