MEDICARE: ROOTS PSYCHIATRY & WELLNESS

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	101YM0800X	Mental Health Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1841170842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTS PSYCHIATRY & WELLNESS

Provider Business Mailing Address
First Line	:	4609 CHARLOTTE HWY STE 3
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8025
Country	:	US
Telephone Number	:	803-373-2598
Fax Number	:	866-884-5371

Provider Business Practice Location Address
First Line	:	4609 CHARLOTTE HWY STE 3
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-8025
Country	:	US
Telephone Number	:	803-373-2598
Fax Number	:	866-884-5371

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. BETH WILSON
Credential	:	PHD, LPCS, LCMHCS
Telephone Number	:	803-675-8227

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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Directions to “ROOTS PSYCHIATRY & WELLNESS ” Practice Location

Language	Start Address	Practice Location

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