Provider Demographics
NPI:1093423493
Name:VELVET PSYCHOTHERAPY COLLECTIVE LCSW PLLC
Entity Type:Organization
Organization Name:VELVET PSYCHOTHERAPY COLLECTIVE LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GHWEINEM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:754-249-2013
Mailing Address - Street 1:215 SE 8TH AVE APT 1500
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3898
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 SE 8TH AVE APT 1500
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3898
Practice Address - Country:US
Practice Address - Phone:754-249-2013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty