Provider Demographics
NPI:1821875147
Name:COLLECTIVE WISDOM PLLC
Entity Type:Organization
Organization Name:COLLECTIVE WISDOM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUME
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-207-0250
Mailing Address - Street 1:312 W KING ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3202
Mailing Address - Country:US
Mailing Address - Phone:304-207-0250
Mailing Address - Fax:
Practice Address - Street 1:312 W KING ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3202
Practice Address - Country:US
Practice Address - Phone:304-207-0250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty