Provider Demographics
NPI:1700501053
Name:THE WELLNESS COLLECTIVE- A MIND BODY AND SOUL EXPERIENCE LLC
Entity Type:Organization
Organization Name:THE WELLNESS COLLECTIVE- A MIND BODY AND SOUL EXPERIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-563-2252
Mailing Address - Street 1:418 BROADWAY STE 8044
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2922
Mailing Address - Country:US
Mailing Address - Phone:347-563-2252
Mailing Address - Fax:
Practice Address - Street 1:10046 198TH ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-3323
Practice Address - Country:US
Practice Address - Phone:347-563-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)