Provider Demographics
NPI:1922833706
Name:ENLIGHTENED SOULS, LLC
Entity type:Organization
Organization Name:ENLIGHTENED SOULS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-432-3165
Mailing Address - Street 1:822 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2725
Mailing Address - Country:US
Mailing Address - Phone:614-432-3165
Mailing Address - Fax:
Practice Address - Street 1:670 MERIDIAN WAY
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7648
Practice Address - Country:US
Practice Address - Phone:614-432-3165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0289779Medicaid