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General NPI Number Information
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NPI Number | 1770411134
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Entity Type | Organization
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Legal Business Name | ROOTED IN REAL WELLNESS, LLC
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Dates
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Enumeration Date | 05/13/2026
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Last Update Date | 05/13/2026
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Provider Practice Location Address
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Address Line | 2469 TOMOKA DR
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City | BETHLEHEM
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State | GA
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Zip | 30620-4762
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Country | US
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Telephone | 678-370-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 8735 DUNWOODY PL STE R
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City | ATLANTA
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State | GA
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Zip | 30350-2995
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Country | US
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Telephone | 678-370-7770
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CLINICIAN
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Name | D'ANGELA MARK
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Credential | LMFT
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Telephone | 678-370-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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