Provider Demographics
NPI:1134943848
Name:SOLSTICE CHILD AND FAMILY WELLNESS PLLC
Entity type:Organization
Organization Name:SOLSTICE CHILD AND FAMILY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:407-803-2390
Mailing Address - Street 1:9214 N VICKSBURG PARK CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9214 N VICKSBURG PARK CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-7640
Practice Address - Country:US
Practice Address - Phone:407-803-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251S00000XAgenciesCommunity/Behavioral Health