Healthcare Provider Details

I. General information

NPI: 1265350342
Provider Name (Legal Business Name): ROOTED IN RESILIENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E JUNEAU AVE
MILWAUKEE WI
53203-3904
US

IV. Provider business mailing address

PO BOX 510021
MILWAUKEE WI
53203-0011
US

V. Phone/Fax

Practice location:
  • Phone: 414-293-3918
  • Fax:
Mailing address:
  • Phone:
  • 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: MARINA AWES
Title or Position: THERAPIST
Credential: LPC, CSAC
Phone: 608-239-8074