Basic Information
| Provider Information | |||||||||
| NPI: | 1770060006 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUL'S NEST COUNSELING & WELLNESS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 ROBERTS RD | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038204655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035470513 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 SHATTUCK WAY | ||||||||
| Address2: | |||||||||
| City: | NEWINGTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038018004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034316677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2018 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | GENET | ||||||||
| AuthorizedOfficialFirstName: | CARLI | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6035470513 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 2081 | NH | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.