Healthcare Provider Details

I. General information

NPI: 1174465520
Provider Name (Legal Business Name): ROOTED MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 LONSDALE AVE APT 2
CENTRAL FALLS RI
02863-2430
US

IV. Provider business mailing address

590 LONSDALE AVE APT 2
CENTRAL FALLS RI
02863-2430
US

V. Phone/Fax

Practice location:
  • Phone: 401-400-0869
  • Fax: 401-400-0869
Mailing address:
  • Phone: 401-400-0869
  • Fax: 401-400-0869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TERICA WINTERS
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential: WINTERS
Phone: 401-400-0869