Healthcare Provider Details

I. General information

NPI: 1326854076
Provider Name (Legal Business Name): DWELL THERAPY COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2024
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WALNUT ST
PHILADELPHIA PA
19102-2944
US

IV. Provider business mailing address

1500 CHESTNUT ST STE 2
PHILADELPHIA PA
19102-2700
US

V. Phone/Fax

Practice location:
  • Phone: 215-385-3095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY RAGIN
Title or Position: OWNER
Credential:
Phone: 336-209-3827