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Organization
THE WELLNESS COLLECTIVE BOUTIQUE
Active
Organization
THE WELLNESS COLLECTIVE BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NYESHA LOGAN LCSW (CO-OWNER)
(407) 921-6276
Entity
Organization
Contact information
Practice address
7901 4TH ST N STE 300, ST PETERSBURG, FL 33702-4399
(407) 921-6276
Mailing address
5707 CREEK DALE DR, ORLANDO, FL 32810-3981
(407) 921-6276
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/18/2025
Last updated
08/18/2025
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