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General NPI Number Information
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NPI Number | 1376448332
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Entity Type | Organization
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Legal Business Name | ROOT & RENEWAL COUNSELING
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Dates
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Enumeration Date | 10/10/2026
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Last Update Date | 10/10/2026
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Provider Practice Location Address
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Address Line | 409 DARTMOOR DR
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City | KILLEN
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State | AL
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Zip | 35645-5164
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Country | US
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Telephone | 256-390-2911
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Fax |
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Provider Business Mailing Address
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Address Line | 409 DARTMOOR DR
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City | KILLEN
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State | AL
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Zip | 35645-5164
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Country | US
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Telephone | 256-390-2911
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ELIZABETH GRAVES
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Credential | LICSW
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Telephone | 256-390-2911
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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 | NULL
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