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General NPI Number Information
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NPI Number | 1124804471
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Entity Type | Organization
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Legal Business Name | HEALING ROOTS PLLC
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 1755 PARK ST STE 200
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City | NAPERVILLE
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State | IL
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Zip | 60563-8404
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Country | US
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Telephone | 331-207-4045
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Fax |
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Provider Business Mailing Address
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Address Line | 7905 KNOTTINGHAM CIR APT B
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City | DARIEN
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State | IL
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Zip | 60561-4969
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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 | OWNER
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Name | DEBORAH KNIGHT
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Credential | LCPC
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Telephone | 312-799-0739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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