Provider Demographics
NPI:1376117218
Name:ROOTS & WINGS WELLNESS LLC
Entity Type:Organization
Organization Name:ROOTS & WINGS WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-398-2136
Mailing Address - Street 1:1947 SILVERWEED WAY
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4621
Mailing Address - Country:US
Mailing Address - Phone:352-398-2136
Mailing Address - Fax:
Practice Address - Street 1:1947 SILVERWEED WAY
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4621
Practice Address - Country:US
Practice Address - Phone:352-398-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health