Provider Demographics
NPI:1851994883
Name:CULTIVATE CONSCIOUSLY WELLNESS COUNSELING, LLC
Entity Type:Organization
Organization Name:CULTIVATE CONSCIOUSLY WELLNESS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTEN
Authorized Official - Middle Name:ELAINA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LPC, BC-TMH
Authorized Official - Phone:508-669-7166
Mailing Address - Street 1:210 PARK AVE STE 231
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2246
Mailing Address - Country:US
Mailing Address - Phone:508-659-2380
Mailing Address - Fax:774-243-0597
Practice Address - Street 1:210 PARK AVE STE 231
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2246
Practice Address - Country:US
Practice Address - Phone:508-659-2380
Practice Address - Fax:774-243-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty