Provider Demographics
NPI:1619859410
Name:ROOTS & WINGS COUNSELING SERVICES
Entity type:Organization
Organization Name:ROOTS & WINGS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:COLISTRO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-403-0039
Mailing Address - Street 1:1425 N MARCASITE CT
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6921
Mailing Address - Country:US
Mailing Address - Phone:509-863-3510
Mailing Address - Fax:
Practice Address - Street 1:1425 N MARCASITE CT
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6921
Practice Address - Country:US
Practice Address - Phone:509-863-3510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1982470449Medicaid