Provider Demographics
NPI:1073026498
Name:ROOTS COUNSELING, PLLC.
Entity Type:Organization
Organization Name:ROOTS COUNSELING, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/LICENSED COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC, LBSW
Authorized Official - Phone:517-392-1814
Mailing Address - Street 1:410 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1224
Mailing Address - Country:US
Mailing Address - Phone:517-392-1814
Mailing Address - Fax:
Practice Address - Street 1:180 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1345
Practice Address - Country:US
Practice Address - Phone:517-392-1814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009840101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty