Provider Demographics
NPI:1477782670
Name:ROOTS & WINGS INDIVIDUAL AND FAMILY COUNSELING ASSOCIATES INC
Entity Type:Organization
Organization Name:ROOTS & WINGS INDIVIDUAL AND FAMILY COUNSELING ASSOCIATES INC
Other - Org Name:ROOTS & WINGS CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-737-7721
Mailing Address - Street 1:7918 EL CAJON BLVD
Mailing Address - Street 2:SUITE N #307
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-3710
Mailing Address - Country:US
Mailing Address - Phone:619-737-7721
Mailing Address - Fax:
Practice Address - Street 1:8356 ALLISON AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3857
Practice Address - Country:US
Practice Address - Phone:619-737-7721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS235101041C0700X
CAMFCC45648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty