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General NPI Number Information
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NPI Number | 1457865586
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Entity Type | Organization
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Legal Business Name | SOUL CARE SOLUTION LLC
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 17825 MURDOCK CIR STE 1B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-4000
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Country | US
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Telephone | 941-235-7215
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Fax | 941-255-5055
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Provider Business Mailing Address
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Address Line | 17825 MURDOCK CIR STE 1B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-4000
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Country | US
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Telephone | 941-235-7215
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Fax | 941-255-5055
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Authorized Official
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Title or Position | DIRECTOR/CLINICIAN
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Name | DR. CYNTHIA LEE CHAUSSE
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Credential | ED.D. L.M.H.C.
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Telephone | 941-235-7215
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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 | MH3566
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | MH3566
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH3566
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License Number State | FL
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