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General NPI Number Information
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NPI Number | 1669386025
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Entity Type | Organization
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Legal Business Name | THE SOUL REMEDIATION CENTER LLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 15616 GILPIN MEWS LN
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City | BRANDYWINE
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State | MD
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Zip | 20613-6277
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Country | US
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Telephone | 202-751-6444
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Fax |
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Provider Business Mailing Address
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Address Line | 15616 GILPIN MEWS LN
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City | BRANDYWINE
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State | MD
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Zip | 20613-6277
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Country | US
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Telephone | 202-751-6444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEAN BAXTER
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Credential |
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Telephone | 202-751-6444
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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 | NULL
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