Provider Demographics
NPI:1790659316
Name:SOULARIS COUNSELING PLLC
Entity type:Organization
Organization Name:SOULARIS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA
Authorized Official - Phone:757-846-6147
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-0121
Mailing Address - Country:US
Mailing Address - Phone:252-300-7267
Mailing Address - Fax:
Practice Address - Street 1:135 CROOKED BACK LOOP
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3701
Practice Address - Country:US
Practice Address - Phone:252-300-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty