MEDICARE: RESILIENT ROOTS PARENTING & LIFE COACHING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1639003221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESILIENT ROOTS PARENTING & LIFE COACHING, LLC

Provider Business Mailing Address
First Line	:	125 LAZY WATER DR
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-1703
Country	:	US
Telephone Number	:	405-824-4786
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 LAZY WATER DR
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-1703
Country	:	US
Telephone Number	:	405-824-4786
Fax Number	:

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	DAISHA A CARTWRIGHT
Credential	:	BCBA
Telephone Number	:	405-824-4786

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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