Provider Demographics
NPI:1235535303
Name:SOUL PERFECT BALANCE
Entity Type:Organization
Organization Name:SOUL PERFECT BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRADITIONAL NATUROPATH
Authorized Official - Prefix:MS
Authorized Official - First Name:HADASSAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NATIONS
Authorized Official - Suffix:
Authorized Official - Credentials:HHP,NP, BCC
Authorized Official - Phone:858-461-9854
Mailing Address - Street 1:3960 W PT LOMA BLVD H185
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110
Mailing Address - Country:US
Mailing Address - Phone:858-461-9865
Mailing Address - Fax:
Practice Address - Street 1:3960 W POINT LOMA BLVD # H185
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5643
Practice Address - Country:US
Practice Address - Phone:858-461-9865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty