Healthcare Provider Details

I. General information

NPI: 1003771692
Provider Name (Legal Business Name): ROOTED AND RISING COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 BENTGRASS RUN DR
CHARLOTTE NC
28269-6129
US

IV. Provider business mailing address

5121 BENTGRASS RUN DR
CHARLOTTE NC
28269-6129
US

V. Phone/Fax

Practice location:
  • Phone: 704-999-9488
  • Fax:
Mailing address:
  • Phone: 704-999-9488
  • 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: BREANNA JULEEN KING
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: LCMHC-A
Phone: 704-999-9488