Provider Demographics
NPI:1871232082
Name:ROOTED THERAPY CENTER LLC
Entity Type:Organization
Organization Name:ROOTED THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:DARRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DROSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-242-2710
Mailing Address - Street 1:101 W BIG BEAVER RD STE 1400
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 W BIG BEAVER RD STE 1400
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5295
Practice Address - Country:US
Practice Address - Phone:586-242-2710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty