Healthcare Provider Details

I. General information

NPI: 1124621750
Provider Name (Legal Business Name): JOYFUL SOUL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4561 HIGHWAY 17 BYP S
MYRTLE BEACH SC
29577-6680
US

IV. Provider business mailing address

4561 HIGHWAY 17 BYP S
MYRTLE BEACH SC
29577-6680
US

V. Phone/Fax

Practice location:
  • Phone: 843-274-9540
  • Fax: 843-293-7685
Mailing address:
  • Phone: 843-274-9540
  • Fax: 843-293-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHETTE MELINDA DOTSON
Title or Position: LPC
Credential: LPC
Phone: 843-274-9540