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General NPI Number Information
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NPI Number | 1760326904
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Entity Type | Organization
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Legal Business Name | DEEP ROOTS HEALING, LLC
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Dates
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Enumeration Date | 04/17/2026
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Last Update Date | 04/17/2026
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Provider Practice Location Address
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Address Line | 497 HOGAN DR
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City | MARTINSBURG
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State | WV
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Zip | 25405-6899
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Country | US
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Telephone | 304-671-4531
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Fax | 301-992-6975
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Provider Business Mailing Address
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Address Line | 497 HOGAN DR
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City | MARTINSBURG
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State | WV
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Zip | 25405-6899
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Country | US
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Telephone | 301-992-6975
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Fax | 301-992-6975
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | CAROLYN LEIGH GEORGE
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Credential | LICSW, LCSW, MS
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Telephone | 304-671-4531
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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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