Organization
CONNECTED ROOTS YOUTH COUNSELING SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STACEY BRISTOW BS (OWNER)
(740) 807-1506
Entity
Organization
Contact information
Practice address
300 ASHLEY PARK BLVD APT 2014, NEWNAN, GA 30263-6419
(740) 807-1506
(678) 306-8663
Mailing address
300 ASHLEY PARK BLVD APT 2014, NEWNAN, GA 30263-6419
(917) 474-3083
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
10/13/2021
Last updated
03/28/2022
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