Healthcare Provider Details

I. General information

NPI: 1356056782
Provider Name (Legal Business Name): SOUL SOIL HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CLIPPER MILL RD STE 221
BALTIMORE MD
21211-1946
US

IV. Provider business mailing address

3600 CLIPPER MILL RD STE 221
BALTIMORE MD
21211-1946
US

V. Phone/Fax

Practice location:
  • Phone: 442-320-2313
  • Fax:
Mailing address:
  • Phone: 442-320-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTOPHER T GEBHARD
Title or Position: FOUNDER/CEO
Credential: PHD
Phone: 218-280-2750