Provider Demographics
NPI:1407429251
Name:DEEPLY ROOTED FAMILY SERVICES
Entity type:Organization
Organization Name:DEEPLY ROOTED FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMHC
Authorized Official - Phone:980-280-5904
Mailing Address - Street 1:1 BUFFALO AVE NW STE 201
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4004
Mailing Address - Country:US
Mailing Address - Phone:980-280-5904
Mailing Address - Fax:
Practice Address - Street 1:1 BUFFALO AVE NW STE 201
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4004
Practice Address - Country:US
Practice Address - Phone:980-280-5904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty