Healthcare Provider Details

I. General information

NPI: 1093626988
Provider Name (Legal Business Name): ROOTED RELATIONSHIPS COUNSELING & RECOVERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WAXHAW PROFESSIONAL PARK DR STE D
WAXHAW NC
28173-5020
US

IV. Provider business mailing address

841 SPRING OAKS DR
MATTHEWS NC
28104-5416
US

V. Phone/Fax

Practice location:
  • Phone: 704-255-4708
  • Fax: 704-255-4708
Mailing address:
  • Phone: 704-400-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LISA A BIVENS
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LCMHCA, LCASA
Phone: 704-400-1215