Provider Demographics
NPI:1649169053
Name:STAY ROOTED COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:STAY ROOTED COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-345-8061
Mailing Address - Street 1:3701 ASHBROOK DR NW APT 405
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-7623
Mailing Address - Country:US
Mailing Address - Phone:321-334-7417
Mailing Address - Fax:
Practice Address - Street 1:910 BEACON ST NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7835
Practice Address - Country:US
Practice Address - Phone:321-345-8061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty