Provider Demographics
NPI:1427728773
Name:NEW ROOTS NUTRITION COUNSELING, LLC
Entity type:Organization
Organization Name:NEW ROOTS NUTRITION COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, RD, LD
Authorized Official - Phone:207-977-4700
Mailing Address - Street 1:40 FOREST FALLS DR STE 305
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-7010
Mailing Address - Country:US
Mailing Address - Phone:207-977-4700
Mailing Address - Fax:207-977-4900
Practice Address - Street 1:40 FOREST FALLS DR STE 305
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-7010
Practice Address - Country:US
Practice Address - Phone:207-977-4700
Practice Address - Fax:207-977-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty