Healthcare Provider Details

I. General information

NPI: 1043137904
Provider Name (Legal Business Name): WHOLE SOUL COUNSEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 VESPER CIR
MAULDIN SC
29662-2522
US

IV. Provider business mailing address

220 VESPER CIR
MAULDIN SC
29662-2522
US

V. Phone/Fax

Practice location:
  • Phone: 864-214-4214
  • Fax:
Mailing address:
  • Phone: 864-214-4214
  • 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: DR. KENNETH BROWN II
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC-A
Phone: 352-840-3036