Healthcare Provider Details

I. General information

NPI: 1134054497
Provider Name (Legal Business Name): COLLECTIVE FOR EMPOWERED MENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 OHIO AVENUE
ALTAMONTE SPRINGS FL
32714
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 321-515-4914
  • Fax:
Mailing address:
  • Phone: 321-515-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRIA VICTORIA KETCHERSID
Title or Position: OWNER
Credential: LCSW
Phone: 321-515-4914