Provider Demographics
NPI:1972521755
Name:ROOTS, MICHAEL VINCENT (LCSW, CAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:ROOTS
Suffix:
Gender:M
Credentials:LCSW, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC3
Mailing Address - Street 2:BOX 1624
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09021
Mailing Address - Country:US
Mailing Address - Phone:0049637-191-5800
Mailing Address - Fax:
Practice Address - Street 1:INSTALLATION MANAGEMENT AGENCY-E
Practice Address - Street 2:ATTN:SFIM-EU-HR (SAIC-ASACS) UNIT 29353 BOX 200
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09014
Practice Address - Country:US
Practice Address - Phone:0049622-116-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4089101YA0400X
PA011768L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical