Provider Demographics
NPI:1952008849
Name:ROOTS WELLNESS COUNSELING LLC
Entity Type:Organization
Organization Name:ROOTS WELLNESS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANESE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-208-3210
Mailing Address - Street 1:19041 CANTERBURY PL
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5254
Mailing Address - Country:US
Mailing Address - Phone:708-654-5200
Mailing Address - Fax:
Practice Address - Street 1:19041 CANTERBURY PL
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5254
Practice Address - Country:US
Practice Address - Phone:708-654-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health