Provider Demographics
NPI:1407468473
Name:ROOTED THERAPY
Entity Type:Organization
Organization Name:ROOTED THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER (AM)
Authorized Official - Prefix:DR
Authorized Official - First Name:PORSHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:910-257-6587
Mailing Address - Street 1:9000 SHERIDAN ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8802
Mailing Address - Country:US
Mailing Address - Phone:786-361-3457
Mailing Address - Fax:
Practice Address - Street 1:9000 SHERIDAN ST STE 109
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-8802
Practice Address - Country:US
Practice Address - Phone:786-361-3457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty