Provider Demographics
NPI:1821705005
Name:WHOLEHEARTED HEALING COLLECTIVE NJ CORP
Entity Type:Organization
Organization Name:WHOLEHEARTED HEALING COLLECTIVE NJ CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-852-7373
Mailing Address - Street 1:1049 BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1335
Mailing Address - Country:US
Mailing Address - Phone:732-852-7373
Mailing Address - Fax:
Practice Address - Street 1:1049 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1335
Practice Address - Country:US
Practice Address - Phone:732-852-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty