Provider Demographics
NPI:1568172179
Name:CRICKET AND ROOTS
Entity Type:Organization
Organization Name:CRICKET AND ROOTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PARRAVANO DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW, RYT
Authorized Official - Phone:248-227-7672
Mailing Address - Street 1:49018 FREESTONE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8004
Mailing Address - Country:US
Mailing Address - Phone:248-227-7672
Mailing Address - Fax:
Practice Address - Street 1:49018 FREESTONE DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-8004
Practice Address - Country:US
Practice Address - Phone:248-227-7672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)