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Organization

MIND BODY & SOUL BEHAVIORAL HEALTH AND WELLNESS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHUKAIRO M BAKER LCSW, LISW-CP, LCAS (CEO)
(980) 309-8508
Entity
Organization

Contact information

Practice address
1365 EBENEZER RD, ROCK HILL, SC 29732-2336
(803) 708-7556
(803) 708-7801
Mailing address
1365 EBENEZER RD, ROCK HILL, SC 29732-2336
(803) 708-7556
(803) 708-7801

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
02/12/2020
Last updated
02/12/2020
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