Provider Demographics
NPI:1457042004
Name:WOVEN ROOTS CONSULTING PLLC
Entity Type:Organization
Organization Name:WOVEN ROOTS CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GELSTHORPE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, REACE
Authorized Official - Phone:217-821-3010
Mailing Address - Street 1:187 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4504
Mailing Address - Country:US
Mailing Address - Phone:217-821-3010
Mailing Address - Fax:
Practice Address - Street 1:187 DOGWOOD RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4504
Practice Address - Country:US
Practice Address - Phone:217-821-3010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health