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General NPI Number Information
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NPI Number | 1407468473
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Entity Type | Organization
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Legal Business Name | ROOTED THERAPY
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 9000 SHERIDAN ST STE 109
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-8802
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Country | US
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Telephone | 786-361-3457
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 SHERIDAN ST STE 109
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-8802
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Country | US
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Telephone | 786-361-3457
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Fax |
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Authorized Official
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Title or Position | MANAGER (AM)
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Name | DR. PORSHIA CUNNINGHAM
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Credential | LMFT
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Telephone | 910-257-6587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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