Provider Demographics
NPI:1306630199
Name:HEALING THE WOUNDED SOUL LLC
Entity type:Organization
Organization Name:HEALING THE WOUNDED SOUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHARME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-533-6245
Mailing Address - Street 1:644 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6864
Mailing Address - Country:US
Mailing Address - Phone:401-533-6245
Mailing Address - Fax:401-424-4531
Practice Address - Street 1:16 DAKIN AVE STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2826
Practice Address - Country:US
Practice Address - Phone:516-225-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty