NPIMap

Organization Active NPI

Soul-Renity, LLC

  • Professional Counselor
  • Baltimore, MD
National Provider Identifier
1972900595
Registry record updated Nov 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LC2447 Issued in MD
Legal business name
SOUL-RENITY, LLC
Practice address
3602 Mohawk Ave
Suite 200
Baltimore, MD 21207-7665
Phone
(443) 869-6584
Fax
(443) 869-6127
NPI assigned
Nov 25, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2015

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

Authorized official

Name
Ms. Kier M Johnson, LCPC, MS, NCCNPI 1063525673
Title
Owner
Phone
(443) 869-6584

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X LC2447 MD Primary

Addresses

Primary practice location

3602 Mohawk Ave
Suite 200
Baltimore, MD 21207-7665

Mailing address

1800 N Charles St
Suite 204
Baltimore, MD 21201-5920
Phone (443) 869-6584

Other identifiers 3

IdentifierTypeStateIssuer
304800400MedicaidMD
024537200MedicaidMD
062137400MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Soul-Renity LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447891200000",
    "number": "1972900595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 N CHARLES ST",
            "address_2": "SUITE 204",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015920",
            "telephone_number": "443-869-6584",
            "fax_number": "443-869-6127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3602 MOHAWK AVE",
            "address_2": "SUITE 200",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212077665",
            "telephone_number": "443-869-6584",
            "fax_number": "443-869-6127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL-RENITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-25",
        "last_updated": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KIER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-869-6584",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCPC, MS, NCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC2447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "304800400",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "024537200",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "062137400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; 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.