Provider Demographics
NPI:1942945704
Name:SOLACE YOU THERAPY PLLC
Entity Type:Organization
Organization Name:SOLACE YOU THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AUTUMN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-364-9922
Mailing Address - Street 1:29441 JOHN R RD UNIT 71203
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-7108
Mailing Address - Country:US
Mailing Address - Phone:313-364-9922
Mailing Address - Fax:
Practice Address - Street 1:29441 JOHN R RD UNIT 71203
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-7108
Practice Address - Country:US
Practice Address - Phone:313-364-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty