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Organization
MODERN SOUL THERAPY LLC
Active
Organization
MODERN SOUL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALLORY A INGRAM LMHC, LCPC (OWNER)
(740) 408-6407
Entity
Organization
Contact information
Practice address
120 WHITWELL ST UNIT D-106, QUINCY, MA 02169-1998
(740) 408-6407
Mailing address
120 WHITWELL ST UNIT D-106, QUINCY, MA 02169-1998
(740) 408-6407
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09322531
PRIVATE INSURANCE
—
Enumeration date
10/20/2020
Last updated
02/10/2025
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