Provider Demographics
NPI:1932879293
Name:ROOT TO RISE COUNSELING AND RECOVERY SERVICES
Entity Type:Organization
Organization Name:ROOT TO RISE COUNSELING AND RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHALA
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:MOTZNY
Authorized Official - Suffix:
Authorized Official - Credentials:MS/EDS
Authorized Official - Phone:336-408-6917
Mailing Address - Street 1:PO BOX 24941
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-4941
Mailing Address - Country:US
Mailing Address - Phone:336-408-6917
Mailing Address - Fax:336-464-2802
Practice Address - Street 1:713 ASHVIEW DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3422
Practice Address - Country:US
Practice Address - Phone:336-408-6917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health