Healthcare Provider Details

I. General information

NPI: 1457042004
Provider Name (Legal Business Name): WOVEN ROOTS CONSULTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 DOGWOOD RD
BOONE NC
28607-4504
US

IV. Provider business mailing address

187 DOGWOOD RD
BOONE NC
28607-4504
US

V. Phone/Fax

Practice location:
  • Phone: 217-821-3010
  • Fax:
Mailing address:
  • Phone: 217-821-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDREA LYNN GELSTHORPE
Title or Position: OWNER
Credential: LCSW, REACE
Phone: 217-821-3010