Provider Demographics
NPI:1902608094
Name:FIREWEED & CEDAR WELLNESS COLLECTIVE LLC
Entity type:Organization
Organization Name:FIREWEED & CEDAR WELLNESS COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:937-806-6749
Mailing Address - Street 1:4193 6TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-1261
Mailing Address - Country:US
Mailing Address - Phone:937-806-6749
Mailing Address - Fax:
Practice Address - Street 1:3180 PEGER RD STE 170
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5486
Practice Address - Country:US
Practice Address - Phone:937-806-6749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty