Provider Demographics
NPI:1063303881
Name:SOUL FILLED THERAPY LICENSED CLINICAL SOCIAL WORKER PC
Entity type:Organization
Organization Name:SOUL FILLED THERAPY LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLKNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-342-9286
Mailing Address - Street 1:3830 VALLEY CENTRE DR PMB 813
Mailing Address - Street 2:STE 705
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1337 CAMINO DEL MAR STE B
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2504
Practice Address - Country:US
Practice Address - Phone:858-342-9286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty