Provider Demographics
NPI:1801610977
Name:WELL ROOTED MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:WELL ROOTED MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ANTINARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:252-581-1912
Mailing Address - Street 1:138 HIGH DUNE LOOP
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3707
Mailing Address - Country:US
Mailing Address - Phone:525-811-9122
Mailing Address - Fax:
Practice Address - Street 1:3118 N CROATAN HWY STE 206
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-9252
Practice Address - Country:US
Practice Address - Phone:252-581-1912
Practice Address - Fax:252-408-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty