Healthcare Provider Details

I. General information

NPI: 1043036619
Provider Name (Legal Business Name): HEALING EVERY ROOT WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2024
Last Update Date: 11/28/2024
Certification Date: 11/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 BOLTON LN
CROFTON MD
21114-1671
US

IV. Provider business mailing address

2451 BOLTON LN
CROFTON MD
21114-1671
US

V. Phone/Fax

Practice location:
  • Phone: 443-713-9623
  • Fax:
Mailing address:
  • Phone: 443-713-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: APRIL KRISTIN LATSON
Title or Position: CEO
Credential: LCSW-C
Phone: 443-713-9623