Provider Demographics
NPI:1336960905
Name:ROOTED THERAPEUTIC WELLNESS, LLC
Entity type:Organization
Organization Name:ROOTED THERAPEUTIC WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MLADC
Authorized Official - Phone:603-455-5871
Mailing Address - Street 1:182 FLAGHOLE RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03216-4125
Mailing Address - Country:US
Mailing Address - Phone:603-455-5871
Mailing Address - Fax:
Practice Address - Street 1:182 FLAGHOLE RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NH
Practice Address - Zip Code:03216-4125
Practice Address - Country:US
Practice Address - Phone:603-455-5871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty