Provider Demographics
NPI:1851050421
Name:RADIANT SOUL INC
Entity Type:Organization
Organization Name:RADIANT SOUL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FELECYTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN-HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:925-325-4239
Mailing Address - Street 1:3400 COTTAGE WAY STE G2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1474
Mailing Address - Country:US
Mailing Address - Phone:925-325-4239
Mailing Address - Fax:
Practice Address - Street 1:2151 CALIFORNIA ST APT B
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2683
Practice Address - Country:US
Practice Address - Phone:925-325-4239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty