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General NPI Number Information
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NPI Number | 1851050421
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Entity Type | Organization
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Legal Business Name | RADIANT SOUL INC
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 2151 CALIFORNIA ST APT B
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City | CONCORD
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State | CA
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Zip | 94520-2683
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Country | US
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Telephone | 925-325-4239
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 COTTAGE WAY STE G2
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City | SACRAMENTO
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State | CA
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Zip | 95825-1474
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Country | US
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Telephone | 925-325-4239
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | FELECYTIE ROSEN-HANSON
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Credential | LMFT
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Telephone | 925-325-4239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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