Provider Demographics
NPI:1922853126
Name:COMMUNITY & WELLNESS COLLECTIVE
Entity type:Organization
Organization Name:COMMUNITY & WELLNESS COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:CHW, MAADC
Authorized Official - Phone:314-574-4090
Mailing Address - Street 1:121 BERNHARDT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-1200
Mailing Address - Country:US
Mailing Address - Phone:314-574-4090
Mailing Address - Fax:
Practice Address - Street 1:121 BERNHARDT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-1200
Practice Address - Country:US
Practice Address - Phone:314-574-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health