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General NPI Number Information
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NPI Number | 1508300518
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Entity Type | Individual
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Provider Name | BLAKE-ALEXANDRIA ALEXIS COLLINS-WISNIOWSKI B.A., CWC-II
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Gender | Female
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Dates
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Enumeration Date | 12/09/2016
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 1015 NW 56TH TER
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City | GAINESVILLE
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State | FL
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Zip | 32605-4481
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Country | US
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Telephone | 352-835-5520
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Fax |
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Provider Business Mailing Address
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Address Line | 119 ROBINSON LN
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City | SANTA CRUZ
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State | CA
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Zip | 95060-2351
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Country | US
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Telephone | 831-760-2774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 10067ECF1E
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16901
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License Number State | CA
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