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General NPI Number Information
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NPI Number | 1417720202
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Entity Type | Organization
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Legal Business Name | SOUL NETWORK
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 3013 CHAMPION LN SW
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City | CONCORD
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State | NC
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Zip | 28025-6012
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Country | US
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Telephone | 704-890-2971
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Fax |
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Provider Business Mailing Address
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Address Line | 3013 CHAMPION LN SW
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City | CONCORD
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State | NC
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Zip | 28025-6012
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Country | US
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Telephone | 704-890-2971
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SANDRA THOMAS
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Credential | B.A
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Telephone | 704-890-2971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 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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