Provider Demographics
NPI:1427839182
Name:COLLECTIVE CURRENT
Entity type:Organization
Organization Name:COLLECTIVE CURRENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:D'EREDITA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-347-3052
Mailing Address - Street 1:742 MALUNIU AVE
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2163
Mailing Address - Country:US
Mailing Address - Phone:703-347-3052
Mailing Address - Fax:
Practice Address - Street 1:337 ULUNIU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2538
Practice Address - Country:US
Practice Address - Phone:719-357-5702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty