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NPI Code Detail

MEDICARE: HEALING ROOTS COUNSELING LLC

MEDICARE: HEALING ROOTS COUNSELING 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
1101Y00000XCounselor

General Provider Information

NPI Number : 1902376163
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALING ROOTS COUNSELING LLC
Provider Business Mailing Address
First Line : 3773 BUTTERFIELD DR NW
Second Line :
City : KENNESAW
State : GA
Zip : 30152-6989
Country : US
Telephone Number : 678-770-7577
Fax Number :
Provider Business Practice Location Address
First Line : 1690 STONE VILLAGE LN NW STE 601B
Second Line :
City : KENNESAW
State : GA
Zip : 30152-7777
Country : US
Telephone Number : 678-948-5783
Fax Number :
Authorized Official
Title or Position : LICENSED PROFESSIONAL COUNSELOR
Name : KRISTINA TUCKER
Credential : MA, LPC
Telephone Number : 678-948-5783
Provider Enumeration Date : 11/30/2018
Last Update Date : 11/30/2018

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Directions to “HEALING ROOTS COUNSELING LLC ” Practice Location

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