Provider Demographics
NPI:1982160156
Name:HEALING ROOTS BEHAVIORAL HEALTH CENTER, LLC
Entity type:Organization
Organization Name:HEALING ROOTS BEHAVIORAL HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VENESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLSOM
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-649-2762
Mailing Address - Street 1:295 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-0002
Mailing Address - Country:US
Mailing Address - Phone:107-649-2762
Mailing Address - Fax:
Practice Address - Street 1:325C KENNEDY MEMORIAL DR STE 2
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4517
Practice Address - Country:US
Practice Address - Phone:207-649-2762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty