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Organization
DEEP ROOTS WELLNESS, LLC
Active
Organization
DEEP ROOTS WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW HOLLO LPCC-S (OWNER)
(419) 239-2113
Entity
Organization
Contact information
Practice address
8081 ADAMS RIDGE RD, DEFIANCE, OH 43512-9173
(419) 239-2113
(419) 239-2113
Mailing address
105 WESTFIELD AVE, DEFIANCE, OH 43512-1433
(419) 239-2113
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
E0600346
OH
Other
Enumeration date
05/08/2018
Last updated
10/12/2020
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