Vital Roots Inc

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

VITAL ROOTS INC

Practice address

6929 Apple LN Apt 2
Carbondale, IL 62902-0302

Phone

(833) 337-6687

NPI assigned

Mar 10, 2021

Last updated

Mar 10, 2021By 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

Lee Cavender, LCSWNPI 1073198164

Title

Owner and Counselor

Phone

(615) 900-0984

Specialties & licenses 2

Addresses

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.

• Lee Cavender, LCSW

  • Clinical Social Worker
  • Dickson, TN
  • NPI 1073198164

  Mental Health

  NPD (past) Authorized official

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

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615334400000",
    "number": "1720663818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6929 APPLE LN APT 2",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629020302",
            "telephone_number": "833-337-6687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6929 APPLE LN APT 2",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629020302",
            "telephone_number": "833-337-6687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL ROOTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-10",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A",
        "authorized_official_last_name": "CAVENDER",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "OWNER AND COUNSELOR",
        "authorized_official_telephone_number": "615-900-0984",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harold Todd Vaughn, P.T.
• Kayla Faye Vecera
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• Ada Elizabeth Vieceli, PH.D.
• Visionworks Inc (Visionworks)
• Christopher P Vonhake, DO
• Bryana Voss, BS
• Julie Marie Wachtel
• Kendall Marie Wachter, DMD
• Catherine Anne Wade Collie

• Mental Health Clinic/Center (Including Community Mental Health Center) in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.