=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982112025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUL AFFIRMING COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2018
-----------------------------------------------------
Last Update Date | 01/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 318 N COLLEGE ST STE G
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36830-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-539-8051
-----------------------------------------------------
Fax | 205-625-4820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 834
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36831-0834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-539-8051
-----------------------------------------------------
Fax | 205-625-4820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KERRY BAHARANYI
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 334-539-8051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 3830C
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------