Provider Demographics
NPI:1477228153
Name:SOULFUL SUCCESS COUNSELING
Entity Type:Organization
Organization Name:SOULFUL SUCCESS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC-A, LCAS
Authorized Official - Phone:919-764-4601
Mailing Address - Street 1:2555 CAPITOL DR STE 9
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7398
Mailing Address - Country:US
Mailing Address - Phone:919-764-4601
Mailing Address - Fax:
Practice Address - Street 1:2555 CAPITOL DR STE 9
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-7398
Practice Address - Country:US
Practice Address - Phone:919-764-4601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty