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General NPI Number Information
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NPI Number | 1851098651
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Entity Type | Organization
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Legal Business Name | SOULCARE HEALTH, LLC
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 250 CONSTITUTION BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8432
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Country | US
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Telephone | 470-844-0157
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Fax | 678-539-8899
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Provider Business Mailing Address
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Address Line | 780 MARTIN FIELD DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-5270
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Country | US
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Telephone | 678-978-4151
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | GLORY O OSADIAYE
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Credential | APRN
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Telephone | 678-978-4151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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