Self-Soulstice, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC005007 Issued in GA

Legal business name

SELF-SOULSTICE, LLC

Practice address

114 N College St
Statesboro, GA 30458-5309

Phone

(912) 755-7069

Fax

(912) 480-9733

NPI assigned

Nov 12, 2014

Last updated

Nov 12, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. D Dionne Bates, PHDNPI 1366625105

Title

Owner

Phone

(912) 755-7069

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• D Dionne Bates, LPC

  • Professional Counselor
  • Marietta, GA
  • NPI 1366625105
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415750400000",
    "number": "1477959807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HAWTHORNE RD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304586003",
            "telephone_number": "912-755-7069",
            "fax_number": "912-480-9733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 N COLLEGE ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585309",
            "telephone_number": "912-755-7069",
            "fax_number": "912-480-9733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF-SOULSTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-12",
        "last_updated": "2014-11-12",
        "status": "A",
        "authorized_official_last_name": "BATES",
        "authorized_official_first_name": "D",
        "authorized_official_middle_name": "DIONNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-755-7069",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC005007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.