Rooted Wings LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

ROOTED WINGS LLC

Practice address

131 Cameron St
Pacolet, SC 29372-2838

Phone

(864) 398-9322

Fax

(888) 707-1002

NPI assigned

May 7, 2025

Last updated

May 8, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacey L Jackson, LPCNPI 1790926905

Title

Owner

Phone

(864) 398-9322

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stacey L Jackson, LPC

  • Professional Counselor
  • Pacolet, SC
  • NPI 1790926905
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746662400000",
    "number": "1629868252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 CAMERON ST",
            "city": "PACOLET",
            "state": "SC",
            "postal_code": "293722838",
            "telephone_number": "864-398-9322",
            "fax_number": "888-707-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 CAMERON ST",
            "city": "PACOLET",
            "state": "SC",
            "postal_code": "293722838",
            "telephone_number": "864-398-9322",
            "fax_number": "888-707-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTED WINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-07",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-398-9322",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Pacolet, SC
• Providers in Pacolet, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.