Provider Demographics
NPI:1003485913
Name:WHOLE SOUL HEALING INC
Entity Type:Organization
Organization Name:WHOLE SOUL HEALING INC
Other - Org Name:WHOLE SOUL HEALING LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESNICS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-693-4008
Mailing Address - Street 1:4909 HUNTER VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9056
Mailing Address - Country:US
Mailing Address - Phone:732-693-4008
Mailing Address - Fax:
Practice Address - Street 1:4909 HUNTER VILLAGE DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9056
Practice Address - Country:US
Practice Address - Phone:732-693-4008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health