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General NPI Number Information
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NPI Number | 1538969829
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Entity Type | Organization
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Legal Business Name | GROUNDED ROOTS PSYCHOTHERAPY SERVICES PLLC
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Dates
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Enumeration Date | 03/15/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 1923 J N PEASE PL STE 101
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City | CHARLOTTE
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State | NC
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Zip | 28262-4534
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Country | US
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Telephone | 704-593-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 1923 J N PEASE PL STE 101
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City | CHARLOTTE
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State | NC
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Zip | 28262-4534
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Country | US
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Telephone | 704-593-6773
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZAIRE ELISSA KING
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Credential | MA, LMFT
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Telephone | 704-593-6773
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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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