| Soul 2 Sole Wellness, Llc | |
|
400 Renfro Dr Unit 311 Glen Burnie MD 21060-3605 | |
| (443) 292-2809 | |
| Not Available |
| Full Name | Soul 2 Sole Wellness, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 400 Renfro Dr Unit 311, Glen Burnie, Maryland |
| Authorized Official Name and Position | Shandra Parks (CEO/CLINICIAN) |
| Authorized Official Contact | 4432922809 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soul 2 Sole Wellness, Llc 1400 W Lombard St Baltimore MD 21223-3134 Ph: (443) 292-2809 | Soul 2 Sole Wellness, Llc 400 Renfro Dr Unit 311 Glen Burnie MD 21060-3605 Ph: (443) 292-2809 |
| NPI Number | 1679191456 |
|---|---|
| Provider Enumeration Date | 07/08/2020 |
| Last Update Date | 07/08/2020 |
| Certification Date | 07/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679191456 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
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