Provider Demographics
NPI:1477234748
Name:SOULISTIC COUNSELING & THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:SOULISTIC COUNSELING & THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELMA
Authorized Official - Middle Name:PENERMON
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-212-3796
Mailing Address - Street 1:267 JOHN KNOX RD STE 113
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6628
Mailing Address - Country:US
Mailing Address - Phone:850-212-3796
Mailing Address - Fax:
Practice Address - Street 1:267 JOHN KNOX RD STE 113
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6628
Practice Address - Country:US
Practice Address - Phone:850-212-3796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)