MEDICARE: JOURNEY TO JOY COLLECTIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033075635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY TO JOY COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	105 DARLINGTON CT
Second Line	:
City	:	NEW PROVIDENCE
State	:	PA
Zip	:	17560-9005
Country	:	US
Telephone Number	:	856-979-9769
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	856-979-9769
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTLE SMALL-WILLIAMS
Credential	:	M.ED
Telephone Number	:	856-979-9769

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	02/18/2026

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