Healthcare Provider Details

I. General information

NPI: 1962366286
Provider Name (Legal Business Name): ROOT & BLOOM WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7570 RONDEX LN
LEWISVILLE NC
27023-9660
US

IV. Provider business mailing address

7570 RONDEX LN
LEWISVILLE NC
27023-9660
US

V. Phone/Fax

Practice location:
  • Phone: 336-909-5544
  • Fax:
Mailing address:
  • Phone: 336-909-5544
  • 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: SUZANNE BOROFSKY MARIN
Title or Position: OWNER
Credential: LCSW
Phone: 336-701-0112