Healthcare Provider Details

I. General information

NPI: 1518390707
Provider Name (Legal Business Name): FIRMLY ROOTED COUNSELING & CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 DELBURG ST SUITE 105
DAVIDSON NC
28036-6913
US

IV. Provider business mailing address

209 DELBURG ST SUITE 105
DAVIDSON NC
28036-6913
US

V. Phone/Fax

Practice location:
  • Phone: 704-892-8003
  • Fax: 704-892-8222
Mailing address:
  • Phone: 704-892-8003
  • Fax: 704-892-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC006594
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANNIE CARNEGIE SEIER
Title or Position: OWNER, MANAGER, THERAPIST
Credential: MSW, LCSW
Phone: 704-892-8003