Provider Demographics
NPI:1932874799
Name:ROOTED THERAPY P.C.
Entity Type:Organization
Organization Name:ROOTED THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RATAJCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHCS, NCC
Authorized Official - Phone:704-837-1443
Mailing Address - Street 1:301 BELVEDERE LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6544
Mailing Address - Country:US
Mailing Address - Phone:704-837-1443
Mailing Address - Fax:
Practice Address - Street 1:8050 CORPORATE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4594
Practice Address - Country:US
Practice Address - Phone:704-837-1443
Practice Address - Fax:855-807-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty