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General NPI Number Information
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NPI Number | 1194530519
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Entity Type | Organization
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Legal Business Name | ROOTED2THRIVE
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 6961 HERITAGE DR STE B
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-8229
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Country | US
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Telephone | 619-975-3746
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 SE FEDERAL HWY # 1014
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City | STUART
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State | FL
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Zip | 34994-5531
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Country | US
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Telephone | 619-975-3746
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Fax |
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Authorized Official
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Title or Position | MGR/OWNER
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Name | SINIQUA R COPELAND
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Credential | LCSW
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Telephone | 614-496-4515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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