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General NPI Number Information
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NPI Number | 1295489060
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Entity Type | Organization
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Legal Business Name | LIVING ROOTS COUNSELING INC
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 316 ESSEX DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-3541
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Country | US
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Telephone | 239-281-1469
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Fax |
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Provider Business Mailing Address
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Address Line | 316 ESSEX DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-3541
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Country | US
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Telephone | 239-281-1469
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | STEPHANIE MARQUART
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Credential |
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Telephone | 239-281-1469
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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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