Provider Demographics
NPI:1104796754
Name:SOUL IN MOTION THERAPY, LLC
Entity type:Organization
Organization Name:SOUL IN MOTION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW, MPA
Authorized Official - Phone:313-673-4800
Mailing Address - Street 1:600 S PROMENADE BLVD APT 505
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1728
Mailing Address - Country:US
Mailing Address - Phone:313-673-4800
Mailing Address - Fax:
Practice Address - Street 1:600 S PROMENADE BLVD APT 505
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1728
Practice Address - Country:US
Practice Address - Phone:313-673-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty