Healthcare Provider Details

I. General information

NPI: 1508300518
Provider Name (Legal Business Name): BLAKE-ALEXANDRIA ALEXIS COLLINS-WISNIOWSKI B.A., CWC-II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRIA COLLINS-WISNIOWSKI CWC-II

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 NW 56TH TER
GAINESVILLE FL
32605-4481
US

IV. Provider business mailing address

119 ROBINSON LN
SANTA CRUZ CA
95060-2351
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-5520
  • Fax:
Mailing address:
  • Phone: 831-760-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number10067ECF1E
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: