Provider Demographics
NPI:1710655527
Name:SOUL MEETS BODY TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:SOUL MEETS BODY TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:APRIL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:717-353-6274
Mailing Address - Street 1:5218 ROCKERY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17362-8039
Mailing Address - Country:US
Mailing Address - Phone:717-353-6274
Mailing Address - Fax:
Practice Address - Street 1:11 CARLISLE ST STE 304
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2472
Practice Address - Country:US
Practice Address - Phone:717-819-9818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-06
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health