Provider Demographics
NPI:1295444701
Name:SOULISTIC COUNSELING LLC
Entity type:Organization
Organization Name:SOULISTIC COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPCC
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGSTON-FLANNERY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:606-231-2986
Mailing Address - Street 1:225 E PEACHTREE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2596
Mailing Address - Country:US
Mailing Address - Phone:606-261-2060
Mailing Address - Fax:
Practice Address - Street 1:225 E PEACHTREE ST STE 2
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2596
Practice Address - Country:US
Practice Address - Phone:606-261-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty