Provider Demographics
NPI:1356773923
Name:SOL, DAHAM RAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:DAHAM
Middle Name:RAUL
Last Name:SOL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAHAMSARA
Other - Middle Name:RANDIMA
Other - Last Name:SURAWEERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:600 E BROADWAY ST STE 107
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2776
Mailing Address - Country:US
Mailing Address - Phone:989-824-6565
Mailing Address - Fax:833-647-2020
Practice Address - Street 1:600 E BROADWAY ST STE 107
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2776
Practice Address - Country:US
Practice Address - Phone:989-824-6565
Practice Address - Fax:833-647-2020
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical