Healthcare Provider Details

I. General information

NPI: 1194522136
Provider Name (Legal Business Name): ROOTS TO BLOOMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20133 GLEEDSVILLE RD
LEESBURG VA
20175-8856
US

IV. Provider business mailing address

4901 SPRINGBROOK DR
ANNANDALE VA
22003-3938
US

V. Phone/Fax

Practice location:
  • Phone: 202-415-1578
  • Fax:
Mailing address:
  • Phone: 202-415-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: HAFSA SALAHUDDIN
Title or Position: MANAGER
Credential:
Phone: 202-415-1578