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General NPI Number Information
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NPI Number | 1932055035
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Entity Type | Organization
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Legal Business Name | ROOTED AND RADIANT LLC
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 880 BRIGADIER WAY
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City | ABERDEEN
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State | MD
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Zip | 21001-1371
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Country | US
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Telephone | 443-294-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 880 BRIGADIER WAY APT 411
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City | ABERDEEN
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State | MD
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Zip | 21001-1379
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Country | US
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Telephone | 443-294-5510
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. IMANI A CRAIG
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Credential | LCSW-C
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Telephone | 443-615-6643
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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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