Provider Demographics
NPI:1265143390
Name:180 COUNSELING, PLLC
Entity type:Organization
Organization Name:180 COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SOLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-230-2662
Mailing Address - Street 1:108 WAPITI CT SE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3431
Mailing Address - Country:US
Mailing Address - Phone:701-230-2662
Mailing Address - Fax:
Practice Address - Street 1:108 WAPITI CT SE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3431
Practice Address - Country:US
Practice Address - Phone:701-230-2662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND74249Medicaid