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General NPI Number Information
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NPI Number | 1407784598
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Entity Type | Organization
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Legal Business Name | ROOTED SELF COUNSELING PLLC
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 45571 RUISLIP MANOR WAY
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City | STERLING
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State | VA
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Zip | 20166-9239
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Country | US
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Telephone | 571-926-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 45571 RUISLIP MANOR WAY
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City | STERLING
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State | VA
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Zip | 20166-9239
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAXINE IIDA
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Credential |
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Telephone | 571-926-6453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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