MEDICARE: ROOTED AND RADIANT 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1932055035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED AND RADIANT LLC

Provider Business Mailing Address
First Line	:	880 BRIGADIER WAY APT 411
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-1379
Country	:	US
Telephone Number	:	443-294-5510
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 BRIGADIER WAY
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-1371
Country	:	US
Telephone Number	:	443-294-5510
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MS. IMANI A CRAIG
Credential	:	LCSW-C
Telephone Number	:	443-615-6643

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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Directions to “ROOTED AND RADIANT LLC ” Practice Location

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