Provider Demographics
NPI:1457865586
Name:SOUL CARE SOLUTION LLC
Entity Type:Organization
Organization Name:SOUL CARE SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHAUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD LMHC
Authorized Official - Phone:941-235-7215
Mailing Address - Street 1:17825 MURDOCK CIR STE 1B
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-4000
Mailing Address - Country:US
Mailing Address - Phone:941-235-7215
Mailing Address - Fax:941-255-5055
Practice Address - Street 1:17825 MURDOCK CIR STE 1B
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-4000
Practice Address - Country:US
Practice Address - Phone:941-235-7215
Practice Address - Fax:941-255-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3566101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1265818769OtherNPI INDIVIDUAL TYPE 1
FLMH3566OtherMENTAL HEALTH COUNSELOR