Organization
ROOTS SEEDS AND BRANCHES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JULIUS JESSUP PETERSON LCSW (OWNER)
(404) 698-5553
Entity
Organization
Contact information
Practice address
209A SWANTON WAY STE 202, DECATUR, GA 30030-3271
(404) 698-5553
Mailing address
209A SWANTON WAY STE 202, DECATUR, GA 30030-3271
(404) 698-5553
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW005018
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003181948C
—
GA
Enumeration date
04/18/2018
Last updated
04/18/2018
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