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General NPI Number Information
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NPI Number | 1467025783
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Entity Type | Organization
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Legal Business Name | ROOTED HOPE COUNSELING AND CONSULTING PLC
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 3408 W FAIRFAX ST
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-5373
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Country | US
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Telephone | 479-871-4595
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Fax |
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Provider Business Mailing Address
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Address Line | 3408 W FAIRFAX ST
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-5373
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Country | US
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Telephone | 479-871-4595
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | SHANNON ELAINE NEWTON
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Credential | LPC
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Telephone | 479-871-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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