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General NPI Number Information
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NPI Number | 1205548021
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Entity Type | Organization
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Legal Business Name | SOUL & SPIRIT RESTORATIVE CARE LLC
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Dates
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Enumeration Date | 12/23/2022
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 1415 BLANDING ST STE 4
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City | COLUMBIA
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State | SC
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Zip | 29201-2922
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Country | US
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Telephone | 803-042-4794
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Fax |
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Provider Business Mailing Address
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Address Line | 157 MOSS CREEK DR
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City | MARTINEZ
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State | GA
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Zip | 30907-4519
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | JELINDA STOKES
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Credential | PMHNP-BC
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Telephone | 803-942-4794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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