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General NPI Number Information
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NPI Number | 1649635053
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Entity Type | Organization
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Legal Business Name | THE SOULSTICE CENTER INC
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 59 CENTRAL PARK DR NONE
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City | ATLANTA
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State | GA
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Zip | 30354-4132
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Country | US
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Telephone | 678-334-5469
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Fax |
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Provider Business Mailing Address
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Address Line | 59 CENTRAL PARK DR NONE
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City | ATLANTA
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State | GA
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Zip | 30354-4132
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Country | US
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Telephone | 678-334-5469
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MS. DEBRA TAVARAS
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Credential |
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Telephone | 678-334-5469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State | GA
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