Provider Demographics
NPI:1225392418
Name:SOULCARE COUNSELING
Entity Type:Organization
Organization Name:SOULCARE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLEXA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-560-4036
Mailing Address - Street 1:3130 BROCKWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1336
Mailing Address - Country:US
Mailing Address - Phone:616-560-4036
Mailing Address - Fax:
Practice Address - Street 1:4829 E BELTLINE AVE NE
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9747
Practice Address - Country:US
Practice Address - Phone:616-560-4036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-00610101YA0400X
MI6401000047101YP2500X
MI68010465601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty