Healthcare Provider Details

I. General information

NPI: 1740177013
Provider Name (Legal Business Name): ROOT WARRIORZ HERBAL SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W MAIN AVE STE 302
GASTONIA NC
28052-4154
US

IV. Provider business mailing address

511 N LINCOLN ST STE 444
HIGH SHOALS NC
28077-9700
US

V. Phone/Fax

Practice location:
  • Phone: 704-601-5181
  • Fax: 704-240-3393
Mailing address:
  • Phone: 704-601-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMBER JALEASE WHITE
Title or Position: CEO
Credential:
Phone: 313-701-5181