Healthcare Provider Details

I. General information

NPI: 1922826825
Provider Name (Legal Business Name): SOULFUL BALANCE COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HANCOCK ST APT 4
CAMBRIDGE MA
02139-2229
US

IV. Provider business mailing address

PO BOX 290014
CHARLESTOWN MA
02129-0201
US

V. Phone/Fax

Practice location:
  • Phone: 617-249-3192
  • Fax:
Mailing address:
  • Phone: 617-249-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS E BARNES
Title or Position: THERAPIST
Credential: LMHC
Phone: 716-574-6910