Provider Demographics
NPI:1174299283
Name:ROOTS TO GROW BEHAVIORAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:ROOTS TO GROW BEHAVIORAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:609-457-3176
Mailing Address - Street 1:122 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1526
Mailing Address - Country:US
Mailing Address - Phone:609-457-3176
Mailing Address - Fax:
Practice Address - Street 1:122 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1526
Practice Address - Country:US
Practice Address - Phone:609-457-3176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)