Provider Demographics
NPI:1932929288
Name:SOULFUL HEALING CENTER LLC
Entity type:Organization
Organization Name:SOULFUL HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YIANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKALIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCPAT
Authorized Official - Phone:240-715-7991
Mailing Address - Street 1:624 S WOLFE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3034
Mailing Address - Country:US
Mailing Address - Phone:240-715-7991
Mailing Address - Fax:
Practice Address - Street 1:624 S WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3034
Practice Address - Country:US
Practice Address - Phone:240-715-7991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty