Provider Demographics
NPI:1508614124
Name:ROOT IMPACT WELLNESS LLC
Entity Type:Organization
Organization Name:ROOT IMPACT WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VERRICK
Authorized Official - Middle Name:YOHAUN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:205-787-1833
Mailing Address - Street 1:1025 23RD ST S STE 381
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2499
Mailing Address - Country:US
Mailing Address - Phone:205-787-1833
Mailing Address - Fax:
Practice Address - Street 1:1025 23RD ST S STE 381
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2499
Practice Address - Country:US
Practice Address - Phone:205-787-1833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty