Provider Demographics
NPI:1942085261
Name:SOUL SAIL THERAPY, INC
Entity Type:Organization
Organization Name:SOUL SAIL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-379-1244
Mailing Address - Street 1:PO BOX 25462
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-0462
Mailing Address - Country:US
Mailing Address - Phone:401-379-1244
Mailing Address - Fax:
Practice Address - Street 1:1284 BROAD ST UNIT 25462
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-7729
Practice Address - Country:US
Practice Address - Phone:401-379-1244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty