MEDICARE: THE WOMEN'S HEALING 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861277725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WOMEN'S HEALING COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	12651 S DIXIE HWY STE 308
Second Line	:
City	:	PINECREST
State	:	FL
Zip	:	33156-5961
Country	:	US
Telephone Number	:	305-219-6458
Fax Number	:

Provider Business Practice Location Address
First Line	:	4103 BRIARCLIFF GABLES CIR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2447
Country	:	US
Telephone Number	:	305-219-6458
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHINEZE MARTINEZ
Credential	:
Telephone Number	:	305-219-6458

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	09/05/2023

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