Provider Demographics
NPI:1316604879
Name:OLIVIA TESTA SOUL WELLNESS LLC
Entity type:Organization
Organization Name:OLIVIA TESTA SOUL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:PEARL
Authorized Official - Last Name:TESTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:603-520-1490
Mailing Address - Street 1:1 LENNOX ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5513
Mailing Address - Country:US
Mailing Address - Phone:603-520-1490
Mailing Address - Fax:
Practice Address - Street 1:602 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2324
Practice Address - Country:US
Practice Address - Phone:603-520-1490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health