Organization
SOULFUL LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA KOLTON LLP (LLP/OWNER)
(248) 885-0225
Entity
Organization
Contact information
Practice address
74 W LONG LAKE RD STE 100, BLOOMFIELD HILLS, MI 48304-2770
(248) 885-0225
(734) 207-5326
Mailing address
74 W LONG LAKE RD STE 100, BLOOMFIELD HILLS, MI 48304-2770
(248) 885-0225
(734) 207-5326
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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