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General NPI Number Information
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NPI Number | 1154812972
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Entity Type | Organization
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Legal Business Name | HEART & SOUL LLC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 219 LOCUST AVE
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-2300
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Country | US
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Telephone | 732-757-2176
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Fax |
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Provider Business Mailing Address
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Address Line | 219 LOCUST AVE
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-2300
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Country | US
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Telephone | 732-757-2176
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA ROLAND
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Credential | LAC, NCC
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Telephone | 732-757-2176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00146500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37AC00146500
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 929535
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 993732
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 37AC00146500
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License Number State | NJ
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