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General NPI Number Information
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NPI Number | 1902608094
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Entity Type | Organization
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Legal Business Name | FIREWEED & CEDAR WELLNESS COLLECTIVE LLC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 3180 PEGER RD STE 170
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City | FAIRBANKS
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State | AK
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Zip | 99709-5486
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Country | US
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Telephone | 937-806-6749
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Fax |
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Provider Business Mailing Address
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Address Line | 4193 6TH ST APT 8
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City | FORT WAINWRIGHT
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State | AK
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Zip | 99703-1261
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Country | US
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Telephone | 937-806-6749
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VICTORIA MURPHY
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Credential | LCSW
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Telephone | 937-806-6749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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