Organization
ROOTS AND WINGS CONNECTIONS FAMILY COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM RICHARDSON (CREDENTIALING)
(757) 907-2567
Entity
Organization
Contact information
Practice address
1452 KEMP BRIDGE DRIVE, CHESAPEAKE, VA 23320
(757) 876-5063
Mailing address
1452 KEMP BRIDGE DR, CHESAPEAKE, VA 23320-5057
(757) 876-8321
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0701010410
LICENSE
VA
Enumeration date
11/24/2021
Last updated
11/24/2021
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