Healthcare Provider Details

I. General information

NPI: 1225947872
Provider Name (Legal Business Name): SOUL CARE THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 110-2009
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 110-2009
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 872-802-1584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RUTH TEKESTE DICKS
Title or Position: FOUNDER & COUNSELOR
Credential: LCPC
Phone: 872-802-1584