MEDICARE: SOULFUL HEALING AND WELLNESS 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1982551248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOULFUL HEALING AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	28 AUGUST ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02908-2905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 AUGUST ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02908-2905
Country	:	US
Telephone Number	:	401-263-1203
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLYDE HILLIARD
Credential	:
Telephone Number	:	401-263-1203

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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