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General NPI Number Information
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NPI Number | 1841170842
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Entity Type | Organization
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Legal Business Name | ROOTS PSYCHIATRY & WELLNESS
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 4609 CHARLOTTE HWY STE 3
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City | LAKE WYLIE
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State | SC
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Zip | 29710-8025
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Country | US
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Telephone | 803-373-2598
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Fax | 866-884-5371
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Provider Business Mailing Address
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Address Line | 4609 CHARLOTTE HWY STE 3
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City | LAKE WYLIE
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State | SC
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Zip | 29710-8025
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Country | US
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Telephone | 803-373-2598
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Fax | 866-884-5371
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. BETH WILSON
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Credential | PHD, LPCS, LCMHCS
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Telephone | 803-675-8227
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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