Healthcare Provider Details

I. General information

NPI: 1982525614
Provider Name (Legal Business Name): THE ELEMENTAL COLLECTIVE OF HEART HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 FALLS BRIDGE RD
WILLIAMSTOWN VT
05679
US

IV. Provider business mailing address

16 BERGERON ST APT 1
BARRE VT
05641
US

V. Phone/Fax

Practice location:
  • Phone: 802-585-9967
  • Fax:
Mailing address:
  • Phone: 802-585-9967
  • 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: JESSA DENTON
Title or Position: OWNER
Credential:
Phone: 802-585-9967