# HEALING ROOTS THERAPY AND CONSULTING SERVICES LLC.

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

## Provider details

- **NPI number:** 1891448635
- **Authorized official:** ANTOINETTE SHANAE NIPPER LISW-CP (OWNER)
- **Authorized official phone:** (803) 974-9415

## Contact information

- **Practice address:** 105 INDIGO PLACE CT, WEST COLUMBIA, SC 29172-2698
- **Practice address phone:** (803) 974-9415
- **Mailing address:** 105 INDIGO PLACE CT, WEST COLUMBIA, SC 29172-2698
- **Mailing address phone:** (803) 974-9415

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 02/01/2022
- **Last updated:** 02/01/2022