Healthcare Provider Details

I. General information

NPI: 1811804909
Provider Name (Legal Business Name): RADIANT AND ROOTED THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2389 SEDGEMONT DR
WINSTON SALEM NC
27103-9795
US

IV. Provider business mailing address

2389 SEDGEMONT DR
WINSTON SALEM NC
27103-9795
US

V. Phone/Fax

Practice location:
  • Phone: 336-970-0178
  • Fax:
Mailing address:
  • Phone: 336-970-0178
  • 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: CHRISTINA HOLDSCLAW CARTER
Title or Position: LIC CLINICAL MENTAL HEALTH COUNSELO
Credential: LCMHCA
Phone: 336-970-0178