Healthcare Provider Details

I. General information

NPI: 1568374056
Provider Name (Legal Business Name): ROOTED AND RESTORED COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 DERSTINE AVE
LANSDALE PA
19446-3534
US

IV. Provider business mailing address

421 DERSTINE AVE APT D2
LANSDALE PA
19446-3534
US

V. Phone/Fax

Practice location:
  • Phone: 610-256-2498
  • Fax:
Mailing address:
  • Phone: 610-256-2498
  • 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: CHANEL MULBAH
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 610-256-2498