Healthcare Provider Details

I. General information

NPI: 1801610977
Provider Name (Legal Business Name): WELL ROOTED MENTAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 N CROATAN HWY STE 206
KILL DEVIL HILLS NC
27948-9252
US

IV. Provider business mailing address

138 HIGH DUNE LOOP
KITTY HAWK NC
27949-3707
US

V. Phone/Fax

Practice location:
  • Phone: 252-581-1912
  • Fax: 252-408-4318
Mailing address:
  • Phone: 525-811-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA ANNE ANTINARELLA
Title or Position: OWNER
Credential: PMHNP
Phone: 252-581-1912