Organization
ROOTED WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. COURTNEY VILLON-MAGA LICSW (CLINICAL SUPERVISOR)
(857) 204-7067
Entity
Organization
Contact information
Practice address
228 ALMONT ST, MATTAPAN, MA 02126-1487
(857) 204-7067
Mailing address
228 ALMONT ST, MATTAPAN, MA 02126-1487
(857) 204-7067
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
03/12/2021
Last updated
03/12/2021
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