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General NPI Number Information
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NPI Number | 1588116677
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Entity Type | Organization
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Legal Business Name | RED ROAD HOLISTIC HEALTH, INC.
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 18 NE 4TH AVE UNIT 1644
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City | CRYSTAL RIVER
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State | FL
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Zip | 34423-1644
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Country | US
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Telephone | 352-848-3760
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Fax | 352-848-3761
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Provider Business Mailing Address
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Address Line | PO BOX 1644
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City | CRYSTAL RIVER
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State | FL
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Zip | 34423-1644
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Country | US
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Telephone | 352-848-3760
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Fax | 352-848-3761
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | JENNIFER SUITERS
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Credential | LCSW
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Telephone | 352-848-3760
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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 | SW6272
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License Number State | FL
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