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Organization
SOLACE WELLNESS MANAGEMENT SERVICE, LLC
Active
Organization
SOLACE WELLNESS MANAGEMENT SERVICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EZEKIEL JOHNSON SR. (EXECUTIVE DIRECTOR)
(480) 704-4707
Entity
Organization
Contact information
Practice address
4203 S 37TH ST, PHOENIX, AZ 85040-1813
(480) 704-4707
Mailing address
4203 S 37TH ST, PHOENIX, AZ 85040-1813
(480) 704-4707
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
NULL
103K00000X
Behavior Analyst
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
NULL
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
Primary
—
NULL
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Enumeration date
10/25/2012
Last updated
05/07/2015
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