Provider Demographics
NPI:1841962644
Name:ROOTS.
Entity type:Organization
Organization Name:ROOTS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHCA
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-836-0857
Mailing Address - Street 1:PO BOX 873154
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-3154
Mailing Address - Country:US
Mailing Address - Phone:360-836-0857
Mailing Address - Fax:
Practice Address - Street 1:811 NE 112TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5115
Practice Address - Country:US
Practice Address - Phone:360-836-0857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC61186633OtherLICENSE