Healthcare Provider Details

I. General information

NPI: 1912723974
Provider Name (Legal Business Name): MOXIE HEALING COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2778 SAINT JOHNS LN
ELLICOTT CITY MD
21042-2539
US

IV. Provider business mailing address

2778 SAINT JOHNS LN
ELLICOTT CITY MD
21042-2539
US

V. Phone/Fax

Practice location:
  • Phone: 443-821-0425
  • Fax:
Mailing address:
  • Phone: 443-821-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: REBECCA COONEY
Title or Position: CEO
Credential: LCSW-C
Phone: 443-821-0425