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General NPI Number Information
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NPI Number | 1972900595
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Entity Type | Organization
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Legal Business Name | SOUL-RENITY, LLC
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 3602 MOHAWK AVE SUITE 200
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City | BALTIMORE
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State | MD
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Zip | 21207-7665
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Country | US
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Telephone | 443-869-6584
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Fax | 443-869-6127
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Provider Business Mailing Address
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Address Line | 1800 N CHARLES ST SUITE 204
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City | BALTIMORE
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State | MD
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Zip | 21201-5920
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Country | US
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Telephone | 443-869-6584
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Fax | 443-869-6127
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Authorized Official
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Title or Position | OWNER
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Name | MS. KIER M JOHNSON
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Credential | LCPC, MS, NCC
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Telephone | 443-869-6584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC2447
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License Number State | MD
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