Organization
VITAL ROOTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE CAVENDER LCSW (OWNER AND COUNSELOR)
(615) 900-0984
Entity
Organization
Contact information
Practice address
6929 APPLE LN APT 2, CARBONDALE, IL 62902-0302
(833) 337-6687
Mailing address
6929 APPLE LN APT 2, CARBONDALE, IL 62902-0302
(833) 337-6687
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/10/2021
Last updated
03/10/2021
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