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NPI Code Detail

MEDICARE: MINDFULLY ROOTED COLLABORATIVE THERAPY, LLC

MEDICARE: MINDFULLY ROOTED COLLABORATIVE THERAPY, 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1780514901
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDFULLY ROOTED COLLABORATIVE THERAPY, LLC
Provider Business Mailing Address
First Line : 10770 COLUMBIA PIKE STE 300
Second Line :
City : SILVER SPRING
State : MD
Zip : 20901-4439
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10770 COLUMBIA PIKE STE 300
Second Line :
City : SILVER SPRING
State : MD
Zip : 20901-4439
Country : US
Telephone Number : 857-312-3687
Fax Number :
Authorized Official
Title or Position : CLINICAL SOCIAL WORKER/OWNER
Name : TACIA COLON-JOHNSON
Credential : LCSW-C
Telephone Number : 857-312-3687
Provider Enumeration Date : 05/20/2026
Last Update Date : 05/20/2026

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Directions to “MINDFULLY ROOTED COLLABORATIVE THERAPY, LLC ” Practice Location

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