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General NPI Number Information
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NPI Number | 1740831973
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Entity Type | Organization
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Legal Business Name | MINDFUL ROOTS LLC
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Dates
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Enumeration Date | 09/29/2019
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 21287 GARRETT HWY STE 200
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City | OAKLAND
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State | MD
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Zip | 21550-7370
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Country | US
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Telephone | 304-435-8892
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Fax |
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Provider Business Mailing Address
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Address Line | 948 SECOND AVE
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City | FRIENDSVILLE
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State | MD
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Zip | 21531-2062
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Country | US
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Telephone | 304-435-8892
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | SABRINA TASKER
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Credential | LCSW-C
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Telephone | 304-435-8892
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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 | 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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