| Self-soulstice, Llc | |
|
114 N College St Statesboro GA 30458-5309 | |
| (912) 755-7069 | |
| (912) 480-9733 |
| Full Name | Self-soulstice, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 114 N College St, Statesboro, Georgia |
| Authorized Official Name and Position | D Dionne Bates (OWNER) |
| Authorized Official Contact | 9127557069 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Self-soulstice, Llc 111 Hawthorne Rd Statesboro GA 30458-6003 Ph: (912) 755-7069 | Self-soulstice, Llc 114 N College St Statesboro GA 30458-5309 Ph: (912) 755-7069 |
| NPI Number | 1477959807 |
|---|---|
| Provider Enumeration Date | 11/12/2014 |
| Last Update Date | 11/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477959807 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC005007 (Georgia) | Primary |
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