Organization
SOUL JOURNEY THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUPRIYA SHANTI LICSW (FOUNDER, THERAPIST)
(802) 451-6598
Entity
Organization
Contact information
Practice address
167 MAIN ST, SUITE 207E, BRATTLEBORO, VT 05301-7128
(802) 451-6598
Mailing address
167 MAIN ST, BOX 17, BRATTLEBORO, VT 05301-7128
(802) 451-6598
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089.009440
VT
251S00000X
Community/Behavioral Health Agency
089.009440
VT
Other
Enumeration date
11/04/2014
Last updated
08/31/2016
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