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General NPI Number Information
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NPI Number | 1164341988
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Entity Type | Organization
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Legal Business Name | ROOT AND RIDGE COUNSELING AND CONSULTING LLC
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/14/2026
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Provider Practice Location Address
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Address Line | 1904 SHIELDS RD STE B
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City | DALTON
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State | GA
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Zip | 30720-5064
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Country | US
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Telephone | 706-217-8711
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Fax |
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Provider Business Mailing Address
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Address Line | 975 POPLAR SPRINGS RD NW
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City | DALTON
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State | GA
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Zip | 30720-7091
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Country | US
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Telephone | 706-217-8711
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRUCE L BROADRICK JR.
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Credential | PHARM D, LPC
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Telephone | 706-250-0804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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