Roots to Wings, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

22113 Issued in MD

Legal business name

ROOTS TO WINGS, LLC

Practice address

106 E Ridgeville Blvd Ste 4
Mount Airy, MD 21771-5248

Phone

(662) 889-4264

NPI assigned

Apr 29, 2018

Organization subpart

No

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

Authorized official

Name

Andria Palmer

Title

Owner/Therapist

Phone

(662) 889-4264

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1524960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524960000000",
    "number": "1881182475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 PARK AVE",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217715423",
            "telephone_number": "662-889-4264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E RIDGEVILLE BLVD STE 4",
            "city": "MOUNT AIRY",
            "state": "MD",
            "postal_code": "217715248",
            "telephone_number": "662-889-4264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTS TO WINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-29",
        "last_updated": "2018-04-29",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "ANDRIA",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "662-889-4264"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "22113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Mount Airy, MD
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2018; 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.