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General NPI Number Information
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NPI Number | 1619829603
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Entity Type | Organization
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Legal Business Name | RAISED AND ROOTED THERAPEUTIC COLLECTIVE, LLC
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 14800 FARMINGTON RD STE 109
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City | LIVONIA
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State | MI
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Zip | 48154-5464
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Country | US
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Telephone | 734-776-8380
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Fax |
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Provider Business Mailing Address
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Address Line | 14800 FARMINGTON RD STE 109
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City | LIVONIA
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State | MI
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Zip | 48154-5464
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Country | US
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Telephone | 734-776-8380
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. SHANNON N MATHISON
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Credential | MS, LLP
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Telephone | 734-776-8380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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