=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801759501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSE FROM CONCRETE COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4362 APPALACHIAN DR
-----------------------------------------------------
City | FIELDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24089-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-224-8491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4362 APPALACHIAN DR
-----------------------------------------------------
City | FIELDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24089-3464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-224-8491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ARIEL LEE JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 276-224-8491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------