Provider Demographics
NPI:1134257033
Name:BODY AND SOUL THERAPY LLC
Entity type:Organization
Organization Name:BODY AND SOUL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:LISW CP
Authorized Official - Phone:843-795-1100
Mailing Address - Street 1:2045 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-795-1100
Mailing Address - Fax:843-225-4014
Practice Address - Street 1:2045 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-795-1100
Practice Address - Fax:843-225-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7286104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
149647OtherVALUE OPTIONS