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General NPI Number Information
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NPI Number | 1356056782
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Entity Type | Organization
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Legal Business Name | SOUL SOIL HEALING LLC
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 05/03/2024
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Provider Practice Location Address
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Address Line | 3600 ROLAND AVE STE 4
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City | BALTIMORE
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State | MD
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Zip | 21211-2437
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Country | US
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Telephone | 443-320-2313
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33458
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City | BALTIMORE
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State | MD
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Zip | 21218-0408
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Country | US
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Telephone | 218-280-2750
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | DR. KRISTOPHER T GEBHARD
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Credential | PHD
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Telephone | 218-280-2750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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