Provider Demographics
NPI:1205187093
Name:SOLACE COUNSELING SERVICES
Entity Type:Organization
Organization Name:SOLACE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW ACSW
Authorized Official - Phone:616-892-1070
Mailing Address - Street 1:10717 LITTLE BASS CT
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-7605
Mailing Address - Country:US
Mailing Address - Phone:616-892-1070
Mailing Address - Fax:616-892-1073
Practice Address - Street 1:11304 EDGEWATER DR
Practice Address - Street 2:SUITE D
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8499
Practice Address - Country:US
Practice Address - Phone:616-892-1070
Practice Address - Fax:616-892-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010854011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty