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General NPI Number Information
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NPI Number | 1265355242
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Entity Type | Organization
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Legal Business Name | BACK 2 YOUR ROOTS, PLLC
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 546 STATION ST
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City | CLOVER
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State | SC
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Zip | 29710-4077
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Country | US
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Telephone | 704-936-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S MCDOWELL ST STE 125-2517
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City | CHARLOTTE
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State | NC
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Zip | 28204-2623
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Country | US
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Telephone | 704-936-8113
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | TIERRA KIRKLAND
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Credential | LCMHCS, LPCS
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Telephone | 704-936-8113
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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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