Provider Demographics
NPI:1144075953
Name:360 SOUL LLC
Entity type:Organization
Organization Name:360 SOUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBBATO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-673-8956
Mailing Address - Street 1:1052 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1308
Mailing Address - Country:US
Mailing Address - Phone:732-673-8956
Mailing Address - Fax:
Practice Address - Street 1:1052 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1308
Practice Address - Country:US
Practice Address - Phone:732-673-8956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health