Provider Demographics
NPI:1588275325
Name:GROWING ROOTS WELLNESS
Entity type:Organization
Organization Name:GROWING ROOTS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-353-3882
Mailing Address - Street 1:2000 GWYNN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5261
Mailing Address - Country:US
Mailing Address - Phone:443-272-5431
Mailing Address - Fax:
Practice Address - Street 1:2000 GWYNN OAK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5261
Practice Address - Country:US
Practice Address - Phone:443-272-5431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty