Healthcare Provider Details

I. General information

NPI: 1245964832
Provider Name (Legal Business Name): THE COLLECTIVE CONSCIENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 BULL ST
COLUMBIA SC
29201-2506
US

IV. Provider business mailing address

1824 BULL ST
COLUMBIA SC
29201-2506
US

V. Phone/Fax

Practice location:
  • Phone: 803-338-5059
  • Fax:
Mailing address:
  • Phone: 803-338-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE HANKS
Title or Position: CO-OWNER AND LICENSED THERAPIST
Credential: LMFT
Phone: 803-338-5059