Provider Demographics
NPI:1780196972
Name:SOBER LIFE COACH LLC
Entity Type:Organization
Organization Name:SOBER LIFE COACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELLOR
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRALY
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:619-674-3501
Mailing Address - Street 1:6757 FRIARS RD UNIT 14
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6757 FRIARS RD UNIT 14
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5013
Practice Address - Country:US
Practice Address - Phone:619-674-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA042941116101YA0400X, 171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty