Provider Demographics
NPI:1376366021
Name:ROOTED WILLOW PSYCHIATRY PLLC
Entity type:Organization
Organization Name:ROOTED WILLOW PSYCHIATRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP OWNER OF ROOTED WILLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:POIRIER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP
Authorized Official - Phone:571-536-2935
Mailing Address - Street 1:8392 BRIARMONT LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-2755
Mailing Address - Country:US
Mailing Address - Phone:571-536-2935
Mailing Address - Fax:571-376-6638
Practice Address - Street 1:9255 CENTER ST STE 200
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5079
Practice Address - Country:US
Practice Address - Phone:571-536-2935
Practice Address - Fax:571-376-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty