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General NPI Number Information
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NPI Number | 1780335018
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Entity Type | Organization
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Legal Business Name | SOUL COUNSELING SERVICES
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 231 E ALESSANDRO BLVD # 6A138
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City | RIVERSIDE
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State | CA
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Zip | 92508-5084
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Country | US
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Telephone | 951-422-3035
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Fax |
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Provider Business Mailing Address
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Address Line | 231 E ALESSANDRO BLVD # 6A138
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City | RIVERSIDE
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State | CA
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Zip | 92508-5084
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Country | US
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Telephone | 951-422-3035
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. LAURA E GORDILLO
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Credential | LMFT
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Telephone | 951-213-5338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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