Healthcare Provider Details

I. General information

NPI: 1740984368
Provider Name (Legal Business Name): WELLNESS COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 AIRPORT BLVD STE 2-204
MOBILE AL
36609-2241
US

IV. Provider business mailing address

PO BOX 851807
MOBILE AL
36685-1807
US

V. Phone/Fax

Practice location:
  • Phone: 251-480-0070
  • Fax: 251-480-0097
Mailing address:
  • Phone: 251-480-0070
  • Fax: 251-480-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMY COLLINS
Title or Position: CEO
Credential:
Phone: 251-610-1618