Provider Demographics
NPI:1710647060
Name:SAFE ROOTS COUNSELING
Entity Type:Organization
Organization Name:SAFE ROOTS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ODELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOROVATI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-666-2408
Mailing Address - Street 1:4032 ALABAMA ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-6082
Mailing Address - Country:US
Mailing Address - Phone:310-666-2408
Mailing Address - Fax:
Practice Address - Street 1:4075 PARK BLVD STE 102-218
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2670
Practice Address - Country:US
Practice Address - Phone:619-929-0726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center