Provider Demographics
NPI:1790356244
Name:ROOT, BETHANY (LCMHCA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:ROOT
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3559
Mailing Address - Country:US
Mailing Address - Phone:727-643-5594
Mailing Address - Fax:828-544-1201
Practice Address - Street 1:577 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-3559
Practice Address - Country:US
Practice Address - Phone:276-435-5947
Practice Address - Fax:828-544-1201
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16724101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty