Provider Demographics
NPI:1760980858
Name:SOUL TO SOUL, PLLC
Entity Type:Organization
Organization Name:SOUL TO SOUL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:KRISTEN
Authorized Official - Last Name:ROMIG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:561-313-7524
Mailing Address - Street 1:3258 TAMARA DR APT 4
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5633 STRAND BLVD STE 309
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-7383
Practice Address - Country:US
Practice Address - Phone:561-313-7524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT2496OtherLICENSE