MEDICARE: SOUL MEETS BODY TREATMENT CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1710655527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL MEETS BODY TREATMENT CENTER, LLC

Provider Business Mailing Address
First Line	:	11 CARLISLE ST STE 205
Second Line	:
City	:	HANOVER
State	:	PA
Zip	:	17331-2472
Country	:	US
Telephone Number	:	717-819-9818
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 CARLISLE ST STE 205
Second Line	:
City	:	HANOVER
State	:	PA
Zip	:	17331-2472
Country	:	US
Telephone Number	:	717-819-9818
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MRS. KIRSTEN APRIL JOHNSON
Credential	:	LCSW
Telephone Number	:	717-819-9818

Provider Enumeration Date	:	09/06/2021
Last Update Date	:	01/20/2026

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