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General NPI Number Information
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NPI Number | 1104532522
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Entity Type | Organization
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Legal Business Name | ROOT TO THRIVE INTEGRATIVE HEALING
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 221 DONCASTER RD
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City | JOPPA
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State | MD
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Zip | 21085-4413
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Country | US
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Telephone | 443-617-8222
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Fax |
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Provider Business Mailing Address
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Address Line | 4132 E JOPPA RD STE 110-1382
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City | BALTIMORE
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State | MD
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Zip | 21236-2272
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Country | US
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Telephone | 443-900-0565
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. TIFFANY DENISE SMITH
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Credential | LCSW-C
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Telephone | 443-900-0565
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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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