Healthcare Provider Details

I. General information

NPI: 1538881255
Provider Name (Legal Business Name): SOUL PURPOSE WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 STONE ST
JONESBORO AR
72401-4522
US

IV. Provider business mailing address

1318 STONE ST
JONESBORO AR
72401-4522
US

V. Phone/Fax

Practice location:
  • Phone: 501-213-1330
  • Fax: 501-421-2135
Mailing address:
  • Phone: 501-213-1330
  • Fax: 501-421-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATRINA ADAMS
Title or Position: OWNER AND THERAPIST
Credential: LCSW
Phone: 501-213-1330