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General NPI Number Information
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NPI Number | 1710702089
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Entity Type | Organization
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Legal Business Name | REROOTED COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 3011 TOWN CENTER DRIVE STE 130 UNIT 152
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-0049
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Country | US
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Telephone | 984-500-5719
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Fax |
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Provider Business Mailing Address
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Address Line | 4145 TREVINO DR
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City | DURHAM
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State | NC
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Zip | 27704-3282
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Country | US
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Telephone | 984-500-5719
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Fax |
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Authorized Official
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Title or Position | OWNER/LEAD CLINICIAN
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Name | CLARISSA GOODING-AYTCH
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Credential |
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Telephone | 984-500-5719
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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 |
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License Number State |
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