Healthcare Provider Details

I. General information

NPI: 1043133242
Provider Name (Legal Business Name): TRUE NORTH WELLNESS COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8652 SENTRY CIR
NORTH CHARLESTON SC
29420-8368
US

IV. Provider business mailing address

6650 RIVERS AVE STE 105
NORTH CHARLESTON SC
29406-4829
US

V. Phone/Fax

Practice location:
  • Phone: 843-607-6224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA GABRILLE MULLEN
Title or Position: PSYCHOTHERAPIST
Credential: LISW-CP
Phone: 843-944-2304