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General NPI Number Information
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NPI Number | 1588451181
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Entity Type | Organization
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Legal Business Name | FROM ROOTS TO WINGS BEHAVIORAL CONSULTING AND SUPERVISION, LLC
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 885 GOLD HILL RD # 3104
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City | FORT MILL
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State | SC
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Zip | 29708-7946
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Country | US
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Telephone | 803-902-5943
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Fax | 803-675-0443
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Provider Business Mailing Address
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Address Line | 885 GOLD HILL RD # 3104
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City | FORT MILL
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State | SC
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Zip | 29708-7946
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Country | US
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Telephone | 803-902-5943
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Fax | 803-675-0443
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Authorized Official
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Title or Position | OWNER/BEHAVIOR ANALYST
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Name | STEPHANIE M CLEMENTE
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Credential | MS, BCBA
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Telephone | 803-207-1695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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