Provider Demographics
NPI:1770321796
Name:SOUL ESSENTIAL THERAPY LLC
Entity type:Organization
Organization Name:SOUL ESSENTIAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:443-523-8574
Mailing Address - Street 1:153 E CHESTNUT HILL RD STE 209
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4047
Mailing Address - Country:US
Mailing Address - Phone:302-265-4025
Mailing Address - Fax:
Practice Address - Street 1:153 E CHESTNUT HILL RD STE 209
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4047
Practice Address - Country:US
Practice Address - Phone:302-265-4025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty