=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740177013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOT WARRIORZ HERBAL SPA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2025
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 W MAIN AVE STE 302
-----------------------------------------------------
City | GASTONIA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28052-4154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-601-5181
-----------------------------------------------------
Fax | 704-240-3393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 N LINCOLN ST STE 444
-----------------------------------------------------
City | HIGH SHOALS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28077-9700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-601-2646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AMBER JALEASE WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-701-5181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374K00000X
-----------------------------------------------------
Taxonomy Name | Religious Nonmedical Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------