Provider Demographics
NPI:1992183735
Name:SOTERIA ENTERPRISES, PLLC
Entity Type:Organization
Organization Name:SOTERIA ENTERPRISES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW, SSW
Authorized Official - Phone:517-488-2077
Mailing Address - Street 1:2575 SPRING ARBOR RD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3652
Mailing Address - Country:US
Mailing Address - Phone:517-788-8330
Mailing Address - Fax:517-788-9768
Practice Address - Street 1:2575 SPRING ARBOR RD STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3652
Practice Address - Country:US
Practice Address - Phone:517-788-8330
Practice Address - Fax:517-788-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI6801059321251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI8809Medicaid