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General NPI Number Information
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NPI Number | 1427728773
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Entity Type | Organization
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Legal Business Name | NEW ROOTS NUTRITION COUNSELING, LLC
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Dates
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Enumeration Date | 09/17/2021
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 40 FOREST FALLS DR STE 305
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City | YARMOUTH
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State | ME
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Zip | 04096-7010
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Country | US
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Telephone | 207-977-4700
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Fax | 207-977-4900
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Provider Business Mailing Address
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Address Line | 40 FOREST FALLS DR STE 305
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City | YARMOUTH
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State | ME
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Zip | 04096-7010
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Country | US
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Telephone | 207-977-4700
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Fax | 207-977-4900
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Authorized Official
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Title or Position | DIETITIAN/OWNER
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Name | LAUREN WITHERS
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Credential | MED, RD, LD
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Telephone | 207-977-4700
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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 |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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