Provider Demographics
NPI:1124725197
Name:HEALING ROOTS TOGETHER LLC
Entity type:Organization
Organization Name:HEALING ROOTS TOGETHER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:940-224-8539
Mailing Address - Street 1:6 AIREY CT
Mailing Address - Street 2:
Mailing Address - City:JB ANDREWS
Mailing Address - State:MD
Mailing Address - Zip Code:20762-5526
Mailing Address - Country:US
Mailing Address - Phone:940-224-8539
Mailing Address - Fax:
Practice Address - Street 1:6 AIREY CT
Practice Address - Street 2:
Practice Address - City:JB ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762-5526
Practice Address - Country:US
Practice Address - Phone:940-224-8539
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
Yes251S00000XAgenciesCommunity/Behavioral Health