Provider Demographics
NPI:1184411662
Name:STRONG ROOTS & RESILIENT MINDS THERAPY
Entity type:Organization
Organization Name:STRONG ROOTS & RESILIENT MINDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON GARRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-547-9219
Mailing Address - Street 1:12510 NW LYNCH LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-3055
Mailing Address - Country:US
Mailing Address - Phone:908-547-9219
Mailing Address - Fax:
Practice Address - Street 1:12510 NW LYNCH LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-3055
Practice Address - Country:US
Practice Address - Phone:908-547-9219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty