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General NPI Number Information
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NPI Number | 1568236073
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Entity Type | Organization
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Legal Business Name | SOUL-MIND CONNECTION COUNSELING LLC
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Dates
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Enumeration Date | 11/14/2023
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 308 DATELEAF AVE
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City | CAPITOL HEIGHTS
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State | MD
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Zip | 20743-2524
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Country | US
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Telephone | 202-936-6930
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Fax |
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Provider Business Mailing Address
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Address Line | 10530 CAMPUS WAY S # 1270
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-1309
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Country | US
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Telephone | 202-936-6930
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | SESILIA CONCHOLA
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Credential | LICSW, LCSW-C
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Telephone | 202-936-6930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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