Provider Demographics
NPI:1275366890
Name:THE REAL HEAL COLLECTIVE, PLLC
Entity type:Organization
Organization Name:THE REAL HEAL COLLECTIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZURE
Authorized Official - Middle Name:CHAELYN
Authorized Official - Last Name:SMITH-SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-354-0119
Mailing Address - Street 1:1910 PACIFIC AVE
Mailing Address - Street 2:SUITE 2000 PMB 1953
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1910 PACIFIC AVE STE 2000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4540
Practice Address - Country:US
Practice Address - Phone:214-354-0119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty