Provider Demographics
NPI:1740705102
Name:SOLACE PSYCHOTHERAPY
Entity type:Organization
Organization Name:SOLACE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:864-603-8976
Mailing Address - Street 1:15 VILLA RD APT 296
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3080
Mailing Address - Country:US
Mailing Address - Phone:864-603-8976
Mailing Address - Fax:888-774-5337
Practice Address - Street 1:124 EDINBURGH COURT
Practice Address - Street 2:105
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609
Practice Address - Country:US
Practice Address - Phone:864-603-8976
Practice Address - Fax:888-774-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty