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General NPI Number Information
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NPI Number | 1952008849
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Entity Type | Organization
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Legal Business Name | ROOTS WELLNESS COUNSELING LLC
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 19041 CANTERBURY PL
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City | COUNTRY CLUB HILLS
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State | IL
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Zip | 60478-5254
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Country | US
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Telephone | 708-654-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 19041 CANTERBURY PL
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City | COUNTRY CLUB HILLS
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State | IL
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Zip | 60478-5254
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Country | US
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Telephone | 708-654-5200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANESE ADAMS COLLIER
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Credential |
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Telephone | 773-208-3210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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