Healthcare Provider Details

I. General information

NPI: 1750169413
Provider Name (Legal Business Name): ROOTS TO HEALING COUNSELING & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11369 MARKET ST STE B
NORTH LIMA OH
44452-9782
US

IV. Provider business mailing address

PO BOX 432
NORTH LIMA OH
44452-0432
US

V. Phone/Fax

Practice location:
  • Phone: 330-429-1747
  • Fax:
Mailing address:
  • Phone: 330-429-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LORIE J TAYLOR
Title or Position: OWNER
Credential: LPCC
Phone: 330-429-1747