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General NPI Number Information
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NPI Number | 1174989776
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Entity Type | Organization
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Legal Business Name | SOULFUL HEALING, LLC
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 4143 STONEBRIDGE
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City | HOLLY
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State | MI
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Zip | 48442-9531
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Country | US
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Telephone | 248-917-1642
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Fax | 810-652-8062
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Provider Business Mailing Address
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Address Line | 2442 E MAPLE AVE SUITE 204
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City | FLINT
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State | MI
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Zip | 48507-4462
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Country | US
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Telephone | 810-208-2487
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Fax | 810-652-8062
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. HEIDI MCMEEKIN
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Credential | LPC
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Telephone | 248-917-1642
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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 | 6401011782
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License Number State | MI
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