Provider Demographics
NPI:1447824149
Name:ROOTS TO WINGS COUNSELING PLLC
Entity type:Organization
Organization Name:ROOTS TO WINGS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYHARRA
Authorized Official - Middle Name:ANISSA
Authorized Official - Last Name:MEADORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-278-3314
Mailing Address - Street 1:1001 TEXAS BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5153
Mailing Address - Country:US
Mailing Address - Phone:903-702-5001
Mailing Address - Fax:903-306-0655
Practice Address - Street 1:1001 TEXAS BLVD STE 106
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5153
Practice Address - Country:US
Practice Address - Phone:903-702-5001
Practice Address - Fax:903-306-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty