Healthcare Provider Details

I. General information

NPI: 1851763551
Provider Name (Legal Business Name): SOULFUL ESSENTIALS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S BEDFORD ST STE 400
BURLINGTON MA
01803-5108
US

IV. Provider business mailing address

67 S BEDFORD ST STE 400
BURLINGTON MA
01803-5108
US

V. Phone/Fax

Practice location:
  • Phone: 978-398-8780
  • Fax:
Mailing address:
  • Phone: 978-398-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
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: VENITA N QUALLS
Title or Position: OWNER
Credential: LMHC
Phone: 978-398-8780