Provider Demographics
NPI:1558052589
Name:SOUL & SPIRIT SERVICES, LLC
Entity Type:Organization
Organization Name:SOUL & SPIRIT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LLP, CAADC
Authorized Official - Phone:248-640-9777
Mailing Address - Street 1:165 EAGLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1283
Mailing Address - Country:US
Mailing Address - Phone:248-640-9777
Mailing Address - Fax:
Practice Address - Street 1:33150 SCHOOLCRAFT RD STE 102
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1646
Practice Address - Country:US
Practice Address - Phone:734-221-0115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)