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Organization
ROOTS RENEWAL COUNSELING, INC
Active
Organization
ROOTS RENEWAL COUNSELING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE STOCKHAM-RONOLLO MA, LPC, RPT, NCC (DIRECTOR)
(314) 200-5594
Entity
Organization
Contact information
Practice address
61396 S HWY 97 STE 230, BEND, OR 97702-2558
(314) 200-5594
Mailing address
61396 S HWY 97 STE 230, BEND, OR 97702-2558
(314) 200-5594
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/25/2021
Last updated
01/12/2022
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