Healthcare Provider Details

I. General information

NPI: 1679437446
Provider Name (Legal Business Name): MODERN WELLNESS COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 N 20TH STREET
PHILADELPHIA PA
19140
US

IV. Provider business mailing address

2702 S 80TH ST
PHILADELPHIA PA
19153-1103
US

V. Phone/Fax

Practice location:
  • Phone: 445-800-5022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALIYAH HURLING
Title or Position: COFOUNDER
Credential: CRNP
Phone: 445-800-5022