Healthcare Provider Details

I. General information

NPI: 1932994696
Provider Name (Legal Business Name): ROOT INTEGRATIVE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S MAIN ST
MAULDIN SC
29662-2204
US

IV. Provider business mailing address

507 DUNWOODY DR
SIMPSONVILLE SC
29681-4430
US

V. Phone/Fax

Practice location:
  • Phone: 864-662-6840
  • Fax:
Mailing address:
  • Phone: 843-816-5660
  • Fax: 864-448-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA L BLAKE
Title or Position: OWNER/PROVIDER
Credential: APRN
Phone: 843-816-5660