Healthcare Provider Details

I. General information

NPI: 1033063615
Provider Name (Legal Business Name): LIVING STONE ROOTED HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 SAINT LEONARD RD
SAINT LEONARD MD
20685-2888
US

IV. Provider business mailing address

4705 ALLEN EARLIE RD
PRINCE FREDERICK MD
20678-3734
US

V. Phone/Fax

Practice location:
  • Phone: 855-812-8255
  • Fax:
Mailing address:
  • Phone: 301-980-4707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEXIS LIVINGSTON
Title or Position: LICENSED DIETITIAN NUTRITIONIST
Credential: LDN, CNS
Phone: 301-980-4707