Provider Demographics
NPI:1881302396
Name:TWO WOLVES COLLABORATIVE, LLC
Entity type:Organization
Organization Name:TWO WOLVES COLLABORATIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:BOWERMAN
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, MAC
Authorized Official - Phone:704-936-6833
Mailing Address - Street 1:1732 W SANDCROFT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3067
Mailing Address - Country:US
Mailing Address - Phone:704-936-6833
Mailing Address - Fax:
Practice Address - Street 1:4 CARRIAGE LN STE 300C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6050
Practice Address - Country:US
Practice Address - Phone:843-779-2496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)