Provider Demographics
NPI:1497182349
Name:THE WELLNESS COLLECTIVE
Entity Type:Organization
Organization Name:THE WELLNESS COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:802-922-2298
Mailing Address - Street 1:431 PINE ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4726
Mailing Address - Country:US
Mailing Address - Phone:802-540-0186
Mailing Address - Fax:
Practice Address - Street 1:431 PINE ST
Practice Address - Street 2:SUITE 312
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4726
Practice Address - Country:US
Practice Address - Phone:802-540-0186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0097370171100000X
CAAC 15044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty