Provider Demographics
NPI:1669253993
Name:HEALING CENTERED COLLECTIVE LLC
Entity type:Organization
Organization Name:HEALING CENTERED COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYZHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:667-320-2173
Mailing Address - Street 1:2901 ISLAY CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-3140
Mailing Address - Country:US
Mailing Address - Phone:667-320-2173
Mailing Address - Fax:
Practice Address - Street 1:2901 ISLAY CT
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-3140
Practice Address - Country:US
Practice Address - Phone:667-320-2173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty