Healthcare Provider Details

I. General information

NPI: 1760397020
Provider Name (Legal Business Name): RADICAL ROOTS COUNSELING, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 SAM RITTENBERG BLVD # 2J
CHARLESTON SC
29407-4194
US

IV. Provider business mailing address

5126 CRANESBILL WAY
JOHNS ISLAND SC
29455-4949
US

V. Phone/Fax

Practice location:
  • Phone: 517-581-7580
  • Fax:
Mailing address:
  • Phone: 517-581-7580
  • 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: MEGAN KATHERINE DRIZIN
Title or Position: THERAPIST AND OWNER
Credential: LPC
Phone: 843-284-6968