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General NPI Number Information
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NPI Number | 1376366021
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Entity Type | Organization
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Legal Business Name | ROOTED WILLOW PSYCHIATRY PLLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 9255 CENTER ST STE 200
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City | MANASSAS
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State | VA
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Zip | 20110-5079
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Country | US
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Telephone | 571-536-2935
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Fax | 571-376-6638
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Provider Business Mailing Address
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Address Line | 8392 BRIARMONT LN
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City | MANASSAS
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State | VA
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Zip | 20112-2755
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Country | US
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Telephone | 571-536-2935
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Fax | 571-376-6638
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Authorized Official
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Title or Position | PMHNP OWNER OF ROOTED WILLOW
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Name | DR. LISA CAROLYN POIRIER
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Credential | DNP, PMHNP
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Telephone | 571-536-2935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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