| Soul-full Presence Llc | |
|
101 W Park Pl Middletown DE 19709-1324 | |
| (443) 617-5152 | |
| (302) 376-6145 |
| Full Name | Soul-full Presence Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 101 W Park Pl, Middletown, Delaware |
| Authorized Official Name and Position | Jessica L. L. Desrosiers (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 4436175152 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soul-full Presence Llc 105 Nashua Ct Bear DE 19701-3324 Ph: (144) 361-7515 | Soul-full Presence Llc 101 W Park Pl Middletown DE 19709-1324 Ph: (443) 617-5152 |
| NPI Number | 1871161190 |
|---|---|
| Provider Enumeration Date | 06/14/2021 |
| Last Update Date | 06/14/2021 |
| Certification Date | 05/24/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871161190 | NPI | - | NPPES |
| 1003096595 | Other | DE | MEDICARE |
| 471526 | Other | DE | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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