Healthcare Provider Details

I. General information

NPI: 1669386025
Provider Name (Legal Business Name): THE SOUL REMEDIATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15616 GILPIN MEWS LN
BRANDYWINE MD
20613-6277
US

IV. Provider business mailing address

15616 GILPIN MEWS LN
BRANDYWINE MD
20613-6277
US

V. Phone/Fax

Practice location:
  • Phone: 202-751-6444
  • Fax:
Mailing address:
  • Phone: 202-751-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEAN BAXTER
Title or Position: OWNER
Credential:
Phone: 202-751-6444