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General NPI Number Information
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NPI Number | 1063206092
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Entity Type | Organization
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Legal Business Name | WILD ROOTS COUNSELING AND PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 1318 ROUTE 31 STE 2
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City | ANNANDALE
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State | NJ
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Zip | 08801-3136
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Country | US
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Telephone | 908-219-9028
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Fax |
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Provider Business Mailing Address
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Address Line | 971 US HIGHWAY 202 N STE N
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City | BRANCHBURG
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State | NJ
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Zip | 08876-3757
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | KELSEY CHRIST
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Credential | LCSW
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Telephone | 908-219-9028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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