Healthcare Provider Details

I. General information

NPI: 1710702089
Provider Name (Legal Business Name): REROOTED COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 TOWN CENTER DRIVE STE 130 UNIT 152
FAYETTEVILLE NC
28306-0049
US

IV. Provider business mailing address

4145 TREVINO DR
DURHAM NC
27704-3282
US

V. Phone/Fax

Practice location:
  • Phone: 984-500-5719
  • Fax:
Mailing address:
  • Phone: 984-500-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CLARISSA GOODING-AYTCH
Title or Position: OWNER/LEAD CLINICIAN
Credential:
Phone: 984-500-5719