Healthcare Provider Details

I. General information

NPI: 1003485913
Provider Name (Legal Business Name): WHOLE SOUL HEALING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/07/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 HUNTER VILLAGE DR
OOLTEWAH TN
37363-9056
US

IV. Provider business mailing address

4909 HUNTER VILLAGE DR
OOLTEWAH TN
37363-9056
US

V. Phone/Fax

Practice location:
  • Phone: 732-693-4008
  • Fax:
Mailing address:
  • Phone: 732-693-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA FRESNICS
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 732-693-4008