Healthcare Provider Details

I. General information

NPI: 1801654116
Provider Name (Legal Business Name): ROOTED WELLNESS SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 WOODBURY DR
HILLSBOROUGH NC
27278-6620
US

IV. Provider business mailing address

169 BOONE SQUARE ST UNIT 218
HILLSBOROUGH NC
27278-2561
US

V. Phone/Fax

Practice location:
  • Phone: 919-698-8194
  • Fax:
Mailing address:
  • Phone: 919-698-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRICIA CHAPMAN
Title or Position: PRACTICE MANAGER
Credential: LCMHC
Phone: 828-391-0611