Provider Demographics
NPI:1922644541
Name:PEACEFUL SOUL COUNSELING AND GROUP THERAPY
Entity Type:Organization
Organization Name:PEACEFUL SOUL COUNSELING AND GROUP THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:440-502-0890
Mailing Address - Street 1:5707 FALKIRK LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-0664
Mailing Address - Country:US
Mailing Address - Phone:440-502-0890
Mailing Address - Fax:
Practice Address - Street 1:1501 N CHARLOTTE AVE STE B-127
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2525
Practice Address - Country:US
Practice Address - Phone:440-502-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty