# HEALING ROOTS THERAPY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033794003
- **Authorized official:** STEPHANIE WAGNER LCSW (OWNER/MEMBER)
- **Authorized official phone:** (980) 272-8561

## Contact information

- **Practice address:** 6815 OLDECASTLE CT, CHARLOTTE, NC 28277-8404
- **Practice address phone:** (980) 272-8561
- **Mailing address:** 6815 OLDECASTLE CT, CHARLOTTE, NC 28277-8404
- **Mailing address phone:** (980) 272-8561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/11/2021
- **Last updated:** 03/11/2021