| Connected Roots Youth Counseling Services Llc | |
|
300 Ashley Park Blvd Apt 2014 Newnan GA 30263-6419 | |
| (740) 807-1506 | |
| (678) 306-8663 |
| Full Name | Connected Roots Youth Counseling Services Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 300 Ashley Park Blvd Apt 2014, Newnan, Georgia |
| Authorized Official Name and Position | Stacey Bristow (OWNER) |
| Authorized Official Contact | 7408071506 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Connected Roots Youth Counseling Services Llc 300 Ashley Park Blvd Apt 2014 Newnan GA 30263-6419 Ph: (917) 474-3083 | Connected Roots Youth Counseling Services Llc 300 Ashley Park Blvd Apt 2014 Newnan GA 30263-6419 Ph: (740) 807-1506 |
| NPI Number | 1487316808 |
|---|---|
| Provider Enumeration Date | 10/13/2021 |
| Last Update Date | 03/28/2022 |
| Certification Date | 03/28/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487316808 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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