| Grounded Roots Psychotherapy Services Pllc | |
|
1923 J N Pease Pl Ste 101 Charlotte NC 28262-4534 | |
| (704) 593-6773 | |
| Not Available |
| Full Name | Grounded Roots Psychotherapy Services Pllc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1923 J N Pease Pl Ste 101, Charlotte, North Carolina |
| Authorized Official Name and Position | Zaire Elissa King (OWNER) |
| Authorized Official Contact | 7045936773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grounded Roots Psychotherapy Services Pllc 1923 J N Pease Pl Ste 101 Charlotte NC 28262-4534 Ph: (704) 593-6773 | Grounded Roots Psychotherapy Services Pllc 1923 J N Pease Pl Ste 101 Charlotte NC 28262-4534 Ph: (704) 593-6773 |
| NPI Number | 1538969829 |
|---|---|
| Provider Enumeration Date | 03/15/2025 |
| Last Update Date | 08/18/2025 |
| Certification Date | 08/18/2025 |
| Medicare PECOS PAC ID | 3173049921 |
|---|---|
| Medicare Enrollment ID | O20250424002999 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538969829 | NPI | - | NPPES |
| 1376009209 | Other | NC | PERSONAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Zaire King |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376009209 PECOS PAC ID: 4082130836 Enrollment ID: I20250507003182 |
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