Provider Demographics
NPI:1134873474
Name:ROOTS COUNSELING AND WELLNESS, LLC
Entity type:Organization
Organization Name:ROOTS COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, ICADC, CADC
Authorized Official - Phone:814-528-5000
Mailing Address - Street 1:956 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2531
Mailing Address - Country:US
Mailing Address - Phone:814-528-5000
Mailing Address - Fax:
Practice Address - Street 1:956 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2531
Practice Address - Country:US
Practice Address - Phone:814-528-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-06
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty