Provider Demographics
NPI:1356173348
Name:NOURISHING ROOTS COMPREHENSIVE FAMILY SERVICES LLC
Entity type:Organization
Organization Name:NOURISHING ROOTS COMPREHENSIVE FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMMIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-360-5350
Mailing Address - Street 1:4929 KLEE MILL RD S
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9224
Mailing Address - Country:US
Mailing Address - Phone:434-360-5350
Mailing Address - Fax:
Practice Address - Street 1:4929 KLEE MILL RD S
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-9224
Practice Address - Country:US
Practice Address - Phone:434-360-5350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty