Provider Demographics
NPI:1467100883
Name:SOAR & LIVE INC
Entity Type:Organization
Organization Name:SOAR & LIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER-SOUTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD COUNSELING PSY
Authorized Official - Phone:909-401-1759
Mailing Address - Street 1:517 N MOUNTAIN AVE # 216
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5016
Mailing Address - Country:US
Mailing Address - Phone:909-401-1759
Mailing Address - Fax:866-927-8001
Practice Address - Street 1:517 N MOUNTAIN AVE # 216
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5016
Practice Address - Country:US
Practice Address - Phone:909-401-1759
Practice Address - Fax:866-927-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty