Provider Demographics
NPI:1063221976
Name:A S.O.U.L TRAINED
Entity type:Organization
Organization Name:A S.O.U.L TRAINED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-779-6917
Mailing Address - Street 1:10540 ARTHUR DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9740
Mailing Address - Country:US
Mailing Address - Phone:269-779-6917
Mailing Address - Fax:
Practice Address - Street 1:10540 ARTHUR DAVIS RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9740
Practice Address - Country:US
Practice Address - Phone:269-779-6917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health