MEDICARE: SOUL AFFIRMING COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	3830C	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1467990002	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1982112025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL AFFIRMING COUNSELING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 834
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36831-0834
Country	:	US
Telephone Number	:	334-539-8051
Fax Number	:	205-625-4820

Provider Business Practice Location Address
First Line	:	318 N COLLEGE ST STE G
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-3815
Country	:	US
Telephone Number	:	334-539-8051
Fax Number	:	205-625-4820

Authorized Official
Title or Position	:	OWNER
Name	:	KERRY BAHARANYI
Credential	:	LICSW
Telephone Number	:	334-539-8051

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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