Provider Demographics
NPI:1841826658
Name:CULTIVATING R.O.O.T.S., LLC
Entity type:Organization
Organization Name:CULTIVATING R.O.O.T.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:C
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:706-231-2008
Mailing Address - Street 1:6303 FOGGY OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4686
Mailing Address - Country:US
Mailing Address - Phone:404-444-5143
Mailing Address - Fax:800-419-9018
Practice Address - Street 1:6303 FOGGY OAK DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4686
Practice Address - Country:US
Practice Address - Phone:706-231-2008
Practice Address - Fax:800-419-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty