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General NPI Number Information
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NPI Number | 1982482485
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Entity Type | Organization
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Legal Business Name | UPROOTED MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 8037 FAIR OAKS BLVD
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City | CARMICHAEL
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State | CA
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Zip | 95608-6742
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Country | US
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Telephone | 404-988-0512
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 580786
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City | ELK GROVE
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State | CA
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Zip | 95758-0014
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Country | US
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Telephone | 404-988-0512
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELIQUE BAILEY
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Credential | LMFT
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Telephone | 404-988-0512
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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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