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General NPI Number Information
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NPI Number | 1558809178
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Entity Type | Organization
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Legal Business Name | UNDIVIDED SOUL LLC
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 27 SIEMON COMPANY DR STE 315W
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City | WATERTOWN
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State | CT
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Zip | 06795-2654
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Country | US
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Telephone | 203-697-8983
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Fax | 844-436-9123
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Provider Business Mailing Address
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Address Line | 27 SIEMON COMPANY DR STE 315W
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City | WATERTOWN
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State | CT
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Zip | 06795-2654
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Country | US
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Telephone | 203-697-8983
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Fax | 844-436-9123
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | KATHRYN GELINAS
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Credential | LPC
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Telephone | 203-697-8983
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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 | 3103
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License Number State | CT
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