MEDICARE: SOUL WORKS THERAPY AND WELLNESS, PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1740930718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL WORKS THERAPY AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	7513 DANBURY DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7513 DANBURY DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3564
Country	:	US
Telephone Number	:	313-451-1807
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMANTHA SOKOLL
Credential	:	LPC
Telephone Number	:	248-935-7509

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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