Organization
COMMUNITY ROOTS COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JES DIMAS LCSW, LICSW, LSSW (THERAPIST AND FOUNDER)
(503) 583-2121
Entity
Organization
Contact information
Practice address
494 STATE ST STE 270, SALEM, OR 97301-3647
(503) 583-2121
(855) 855-4872
Mailing address
PO BOX 5312, SALEM, OR 97304-0312
(503) 583-2121
(855) 855-4872
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500688776
—
OR
Enumeration date
08/08/2020
Last updated
09/12/2023
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