Healthcare Provider Details

I. General information

NPI: 1932879293
Provider Name (Legal Business Name): ROOT TO RISE COUNSELING AND RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 ASHVIEW DR
WINSTON SALEM NC
27103-3422
US

IV. Provider business mailing address

PO BOX 24941
WINSTON SALEM NC
27114-4941
US

V. Phone/Fax

Practice location:
  • Phone: 336-408-6917
  • Fax:
Mailing address:
  • Phone: 336-408-6917
  • Fax: 336-464-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAHALA PERRY MOTZNY
Title or Position: OWNER
Credential: MS/EDS
Phone: 336-408-6917