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General NPI Number Information
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NPI Number | 1851763551
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Entity Type | Organization
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Legal Business Name | SOULFUL ESSENTIALS, INC
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 67 S BEDFORD ST STE 400
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City | BURLINGTON
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State | MA
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Zip | 01803-5108
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Country | US
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Telephone | 978-398-8780
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Fax |
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Provider Business Mailing Address
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Address Line | 67 S BEDFORD ST STE 400
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City | BURLINGTON
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State | MA
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Zip | 01803-5108
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Country | US
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Telephone | 978-398-8780
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VENITA N QUALLS
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Credential | LMHC
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Telephone | 978-398-8780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 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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