Provider Demographics
NPI:1245729797
Name:ROOTS TO RESULTS COUNSELING, LLC.
Entity type:Organization
Organization Name:ROOTS TO RESULTS COUNSELING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LENISE
Authorized Official - Middle Name:BENZINA
Authorized Official - Last Name:MAZYCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-787-3323
Mailing Address - Street 1:6001 LAKESIDE AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5748
Mailing Address - Country:US
Mailing Address - Phone:804-787-3323
Mailing Address - Fax:
Practice Address - Street 1:6001 LAKESIDE AVE STE 25
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-5748
Practice Address - Country:US
Practice Address - Phone:804-787-3323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040101771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty