Healthcare Provider Details

I. General information

NPI: 1578479994
Provider Name (Legal Business Name): ROOT & RESTORE WELLBEING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11815 FOUNTAIN WAY STE 300
NEWPORT NEWS VA
23606-4448
US

IV. Provider business mailing address

11815 FOUNTAIN WAY STE 300
NEWPORT NEWS VA
23606-4448
US

V. Phone/Fax

Practice location:
  • Phone: 240-448-6146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: ADRIANA SCOTT
Title or Position: OWNER
Credential: LICSW/LCSW
Phone: 240-448-6146