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General NPI Number Information
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NPI Number | 1730764069
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Entity Type | Organization
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Legal Business Name | ROOTS COUNSELING & CONSULTATION LLC
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 856 E 8TH ST STE 1
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-2784
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Country | US
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Telephone | 248-882-1338
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Fax |
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Provider Business Mailing Address
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Address Line | 10220 COSTER RD SW
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City | FIFE LAKE
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State | MI
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Zip | 49633-8218
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Country | US
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Telephone | 248-882-1338
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Fax |
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Authorized Official
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Title or Position | OWNER/MENTAL HEALTH THERAPIST
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Name | ALLISON RENEE WILSON
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Credential | MS, LPC
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Telephone | 231-577-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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