Healthcare Provider Details

I. General information

NPI: 1457071953
Provider Name (Legal Business Name): WHOLE SELF COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5708 UPTAIN RD STE 464
CHATTANOOGA TN
37411-5507
US

IV. Provider business mailing address

5708 UPTAIN RD STE 464
CHATTANOOGA TN
37411-5507
US

V. Phone/Fax

Practice location:
  • Phone: 423-218-2239
  • Fax:
Mailing address:
  • Phone: 423-218-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: ERIN SWEM
Title or Position: CEO
Credential: LPC-MHSP
Phone: 423-218-2239