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General NPI Number Information
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NPI Number | 1932994696
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Entity Type | Organization
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Legal Business Name | ROOT INTEGRATIVE PSYCHIATRY
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 106 W GEORGIA RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2302
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Country | US
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Telephone | 864-662-6840
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Fax |
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Provider Business Mailing Address
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Address Line | 507 DUNWOODY DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4430
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Country | US
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Telephone | 843-816-5660
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Fax | 864-448-1720
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | CHRISTINA L BLAKE
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Credential | APRN
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Telephone | 843-816-5660
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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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