Provider Demographics
NPI:1295430551
Name:SOLACE PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:SOLACE PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-247-2566
Mailing Address - Street 1:3270 LILLY AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3244
Mailing Address - Country:US
Mailing Address - Phone:858-731-7778
Mailing Address - Fax:
Practice Address - Street 1:7817 HERSCHEL AVE STE 202
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4454
Practice Address - Country:US
Practice Address - Phone:858-247-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty