Provider Demographics
NPI:1154217537
Name:ROOTS & WINGS PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:ROOTS & WINGS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOEDUCATIONAL SPECIALI
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-767-4188
Mailing Address - Street 1:961 ROBERTS BRANCH PKWY STE 106 #102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9150
Mailing Address - Country:US
Mailing Address - Phone:803-767-4188
Mailing Address - Fax:
Practice Address - Street 1:710 WILDLIFE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-3464
Practice Address - Country:US
Practice Address - Phone:803-250-5579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty