Provider Demographics
NPI:1326780958
Name:SOFA SPACE LLC
Entity Type:Organization
Organization Name:SOFA SPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROANNA
Authorized Official - Middle Name:QUEENA
Authorized Official - Last Name:STROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-778-6333
Mailing Address - Street 1:PO BOX 942325
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31141-2325
Mailing Address - Country:US
Mailing Address - Phone:678-778-6333
Mailing Address - Fax:
Practice Address - Street 1:2101 RIDGEBROOK WAY NE # 2101
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-8022
Practice Address - Country:US
Practice Address - Phone:678-778-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty