Organization
THE SOUL REMEDIATION CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEAN GLEN OLIVER BAXTER LICSW (OWNER)
(202) 751-6444
Entity
Organization
Contact information
Practice address
1629 K ST NW, WASHINGTON, DC 20006-1602
(202) 751-6444
Mailing address
2513 WEST ST SE, WASHINGTON, DC 20020-4414
(202) 751-6444
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/05/2019
Last updated
12/30/2024
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