Healthcare Provider Details

I. General information

NPI: 1841116605
Provider Name (Legal Business Name): RESTORATIVE ROOTS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 MILL POND LN APT 406
SALISBURY MD
21804-2258
US

IV. Provider business mailing address

2636 N SALISBURY BLVD # 1082
SALISBURY MD
21801-2141
US

V. Phone/Fax

Practice location:
  • Phone: 443-228-8136
  • Fax:
Mailing address:
  • Phone: 443-228-8136
  • 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 State

VIII. Authorized Official

Name: MORGAN MACKENZIE WIXON
Title or Position: PROFESSIONAL COUNSELOR
Credential: LCPC
Phone: 410-845-7953