Healthcare Provider Details

I. General information

NPI: 1841046497
Provider Name (Legal Business Name): ANCESTRAL ROOTS REIKI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S ROSE ST
BALTIMORE MD
21224-3739
US

IV. Provider business mailing address

810 S ROSE ST
BALTIMORE MD
21224-3739
US

V. Phone/Fax

Practice location:
  • Phone: 443-521-5707
  • Fax:
Mailing address:
  • Phone: 443-521-5707
  • Fax:

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: MS. REBECCA WOODWARD
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW-C
Phone: 443-521-5707