Provider Demographics
NPI:1861241705
Name:ROOTED THERAPY GROUP PLLC
Entity type:Organization
Organization Name:ROOTED THERAPY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-585-4950
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:ENKA
Mailing Address - State:NC
Mailing Address - Zip Code:28728-0462
Mailing Address - Country:US
Mailing Address - Phone:828-585-4950
Mailing Address - Fax:
Practice Address - Street 1:2124 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-5704
Practice Address - Country:US
Practice Address - Phone:828-585-4950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty