Provider Demographics
NPI:1376240382
Name:SOLACE COUNSELING,LLC
Entity type:Organization
Organization Name:SOLACE COUNSELING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOOSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADIB
Authorized Official - Suffix:
Authorized Official - Credentials:LPC COUNSELOR
Authorized Official - Phone:928-350-7503
Mailing Address - Street 1:4319 N DRYDEN ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-9397
Mailing Address - Country:US
Mailing Address - Phone:928-350-7503
Mailing Address - Fax:928-441-1220
Practice Address - Street 1:4319 N DRYDEN ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-9397
Practice Address - Country:US
Practice Address - Phone:928-350-7503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)