Provider Demographics
NPI:1568143592
Name:INTERGENERATIONAL HEALING AND WELLNESS COLLECTIVE
Entity Type:Organization
Organization Name:INTERGENERATIONAL HEALING AND WELLNESS COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAEEMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-590-1659
Mailing Address - Street 1:1400 W WASHINGTON ST STE 24
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3236
Mailing Address - Country:US
Mailing Address - Phone:360-590-1659
Mailing Address - Fax:
Practice Address - Street 1:1400 W WASHINGTON ST STE 24
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3236
Practice Address - Country:US
Practice Address - Phone:360-590-1659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty