Healthcare Provider Details

I. General information

NPI: 1750209482
Provider Name (Legal Business Name): ROOTED HEALING & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 AUDREY DR
GASTONIA NC
28054-1921
US

IV. Provider business mailing address

2047 AUDREY DR
GASTONIA NC
28054-1921
US

V. Phone/Fax

Practice location:
  • Phone: 914-338-3908
  • Fax:
Mailing address:
  • Phone: 914-338-3908
  • 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: JENNIFER MEJIA-HOLGUIN
Title or Position: THERAPIST/OWNER
Credential: LMFT
Phone: 914-338-3908