Provider Demographics
NPI:1720741622
Name:SOUL TALK PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:SOUL TALK PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:908-376-9497
Mailing Address - Street 1:84 FOREST HILL PKWY APT 2E
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4721
Mailing Address - Country:US
Mailing Address - Phone:908-376-9497
Mailing Address - Fax:
Practice Address - Street 1:61 S FULLERTON AVE APT 22
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2645
Practice Address - Country:US
Practice Address - Phone:908-936-9497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty