Provider Demographics
NPI:1841046497
Name:ANCESTRAL ROOTS REIKI, LLC
Entity type:Organization
Organization Name:ANCESTRAL ROOTS REIKI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-521-5707
Mailing Address - Street 1:810 S ROSE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3739
Mailing Address - Country:US
Mailing Address - Phone:443-521-5707
Mailing Address - Fax:
Practice Address - Street 1:810 S ROSE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3739
Practice Address - Country:US
Practice Address - Phone:443-521-5707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBECCA WOODWARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty