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General NPI Number Information
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NPI Number | 1134459332
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Entity Type | Organization
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Legal Business Name | SOUL OF A WOMAN SUPPORT SERVICES
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 4018 OLEANDER DR SUITE #3
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City | WILMINGTON
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State | NC
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Zip | 28403-6852
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Country | US
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Telephone | 919-358-9734
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Fax |
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Provider Business Mailing Address
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Address Line | 4018 OLEANDER DRIVE SUITE #3
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City | WILMINGTON
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State | NC
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Zip | 28403-1559
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Country | US
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Telephone | 919-358-9734
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. NATALKA A LOCK MASSEY
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Credential |
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Telephone | 919-358-9734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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