Soul 2 Sole Wellness, LLC

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

SOUL 2 SOLE WELLNESS, LLC

Doing business as

Soul 2 Sole Wellness, LLC

Practice address

400 Renfro Dr Unit 311
Glen Burnie, MD 21060-3605

Phone

(443) 292-2809

NPI assigned

Jul 8, 2020

Last updated

Jul 8, 2020By 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. Shandra Parks, LMSW

Title

Ceo/Clinician

Phone

(443) 292-2809

Specialties & licenses 1

Addresses

Other names 1

• Soul 2 Sole Wellness, LLC Doing business as

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

{
    "created_epoch": "1594166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594166400000",
    "number": "1679191456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 W LOMBARD ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212233134",
            "telephone_number": "443-292-2809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 RENFRO DR UNIT 311",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210603605",
            "telephone_number": "443-292-2809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL 2 SOLE WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-08",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "SHANDRA",
        "authorized_official_title_or_position": "CEO/CLINICIAN",
        "authorized_official_telephone_number": "443-292-2809",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Soul 2 Sole Wellness, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Social Worker in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; 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.