Provider Demographics
NPI:1164019592
Name:ROOTED FAMILY COUNSELING, PLLC
Entity Type:Organization
Organization Name:ROOTED FAMILY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCS
Authorized Official - Phone:704-856-9570
Mailing Address - Street 1:495 CHALK MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-1508
Mailing Address - Country:US
Mailing Address - Phone:704-640-8921
Mailing Address - Fax:
Practice Address - Street 1:17105 KENTON DR STE 207C
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5654
Practice Address - Country:US
Practice Address - Phone:704-856-9570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty