Provider Demographics
NPI:1841170842
Name:ROOTS PSYCHIATRY & WELLNESS
Entity type:Organization
Organization Name:ROOTS PSYCHIATRY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPCS, LCMHCS
Authorized Official - Phone:803-675-8227
Mailing Address - Street 1:4609 CHARLOTTE HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8025
Mailing Address - Country:US
Mailing Address - Phone:803-373-2598
Mailing Address - Fax:866-884-5371
Practice Address - Street 1:4609 CHARLOTTE HWY STE 3
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8025
Practice Address - Country:US
Practice Address - Phone:803-373-2598
Practice Address - Fax:866-884-5371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty