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General NPI Number Information
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NPI Number | 1689167520
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Entity Type | Organization
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Legal Business Name | ROOTS WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 3745 CHEROKEE ST NW STE 606
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City | KENNESAW
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State | GA
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Zip | 30144-6785
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Country | US
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Telephone | 404-849-8230
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Fax |
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Provider Business Mailing Address
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Address Line | 4113 HIDDEN ENCLAVE LN NW
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City | KENNESAW
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State | GA
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Zip | 30152-7781
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY BARKER
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Credential | LPC
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Telephone | 404-849-8230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC004570
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License Number State | GA
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