Healthcare Provider Details

I. General information

NPI: 1790693893
Provider Name (Legal Business Name): TWIN ROOTS THERAPY COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 FREDERICK RD
CATONSVILLE MD
21228-5055
US

IV. Provider business mailing address

1009 FREDERICK RD
CATONSVILLE MD
21228-5055
US

V. Phone/Fax

Practice location:
  • Phone: 240-548-3845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NEENA BISHOP
Title or Position: CO-FOUNDER
Credential:
Phone: 410-370-3038