Provider Demographics
NPI:1427697051
Name:SOUL WISDOM COUNSELING
Entity type:Organization
Organization Name:SOUL WISDOM COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANIGRA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-573-2205
Mailing Address - Street 1:12 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1506
Mailing Address - Country:US
Mailing Address - Phone:207-573-2205
Mailing Address - Fax:
Practice Address - Street 1:12 ELM ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1506
Practice Address - Country:US
Practice Address - Phone:207-573-2205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty