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General NPI Number Information
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NPI Number | 1205711710
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Entity Type | Organization
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Legal Business Name | SAFE ROOTS THERAPY, LLC
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 8862 SHANNON DR.
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City | STERLING HTS
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State | MI
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Zip | 48314
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Country | US
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Telephone | 586-690-9449
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Fax |
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Provider Business Mailing Address
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Address Line | 8862 SHANNON DR.
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City | STERLING HTS
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State | MI
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Zip | 48314
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Country | US
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Telephone | 586-690-9449
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER, LMSW
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Name | ALISHA MIKKELSON
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Credential |
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Telephone | 586-690-9449
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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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