Provider Demographics
NPI:1588451181
Name:FROM ROOTS TO WINGS BEHAVIORAL CONSULTING AND SUPERVISION, LLC
Entity type:Organization
Organization Name:FROM ROOTS TO WINGS BEHAVIORAL CONSULTING AND SUPERVISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:803-207-1695
Mailing Address - Street 1:1801 PACES RIVER AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1081
Mailing Address - Country:US
Mailing Address - Phone:803-902-5943
Mailing Address - Fax:
Practice Address - Street 1:1801 PACES RIVER AVE APT 107
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1081
Practice Address - Country:US
Practice Address - Phone:803-902-5943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty