Organization
HIDDEN ROOTS MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASMARY TINEO QPPMH (QWNER)
(804) 629-2673
Entity
Organization
Contact information
Practice address
205 E BROADWAY STE 200, HOPEWELL, VA 23860-2809
(804) 629-2673
Mailing address
205 E BROADWAY STE 200, HOPEWELL, VA 23860-2809
(804) 629-2673
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/25/2018
Last updated
10/25/2018
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