Provider Demographics
NPI:1851150841
Name:SOLACE KY
Entity Type:Organization
Organization Name:SOLACE KY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:859-493-1593
Mailing Address - Street 1:93 OLD CLEAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42629-2425
Mailing Address - Country:US
Mailing Address - Phone:859-493-1593
Mailing Address - Fax:463-218-9161
Practice Address - Street 1:93 OLD CLEAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:KY
Practice Address - Zip Code:42629-2425
Practice Address - Country:US
Practice Address - Phone:859-493-1593
Practice Address - Fax:463-218-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty