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General NPI Number Information
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NPI Number | 1982160156
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Entity Type | Organization
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Legal Business Name | HEALING ROOTS BEHAVIORAL HEALTH CENTER, LLC
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 325C KENNEDY MEMORIAL DR STE 2
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City | WATERVILLE
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State | ME
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Zip | 04901-4517
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Country | US
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Telephone | 207-649-2762
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Fax |
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Provider Business Mailing Address
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Address Line | 295 ABBOTT RD
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City | WINSLOW
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State | ME
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Zip | 04901-0002
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Country | US
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Telephone | 107-649-2762
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICIAN
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Name | VENESSA FOLSOM
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Credential | LCPC
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Telephone | 207-649-2762
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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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