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Organization
ROOTS THERAPEUTIC SPECIALTY SERVICES
Active
Organization
ROOTS THERAPEUTIC SPECIALTY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA OSIPSOV LMSW (OWNER/CLINICAL THERAPIST)
(616) 481-8919
Entity
Organization
Contact information
Practice address
10263 CHICAGO DR, ZEELAND, MI 49464-1416
(616) 377-2283
Mailing address
10263 CHICAGO DR, ZEELAND, MI 49464-1416
(616) 377-2283
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13582106
CAQH
—
Enumeration date
01/29/2020
Last updated
01/29/2020
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