Provider Demographics
NPI:1215794771
Name:ROOTS COUNSELING, COACHING, AND CONSULTATION LLC
Entity type:Organization
Organization Name:ROOTS COUNSELING, COACHING, AND CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-913-2548
Mailing Address - Street 1:422 WEST CANAL STREET
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466
Mailing Address - Country:US
Mailing Address - Phone:769-926-1137
Mailing Address - Fax:
Practice Address - Street 1:422 WEST CANAL STREET
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466
Practice Address - Country:US
Practice Address - Phone:769-926-1137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty