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General NPI Number Information
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NPI Number | 1235788779
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Entity Type | Organization
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Legal Business Name | SOULSTICE CLINICAL COUNSELING & PROFESSIONAL DEVELOPMENT
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Dates
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Enumeration Date | 09/07/2019
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Last Update Date | 09/07/2019
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Provider Practice Location Address
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Address Line | 300 GARRISONVILLE RD STE 302
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City | STAFFORD
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State | VA
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Zip | 22554-8903
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Country | US
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Telephone | 540-300-1196
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Fax |
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Provider Business Mailing Address
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Address Line | 300 GARRISONVILLE RD STE 302
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City | STAFFORD
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State | VA
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Zip | 22554-8903
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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 | DIRECTOR
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Name | PHYLLIS BURGIN
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Credential |
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Telephone | 540-300-2096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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