# SOLACE WELLNESS MANAGEMENT SERVICE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912250119
- **Authorized official:** MR. EZEKIEL JOHNSON SR. (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (480) 704-4707

## Contact information

- **Practice address:** 4203 S 37TH ST, PHOENIX, AZ 85040-1813
- **Practice address phone:** (480) 704-4707
- **Mailing address:** 4203 S 37TH ST, PHOENIX, AZ 85040-1813
- **Mailing address phone:** (480) 704-4707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 103TR0400X | Rehabilitation Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 10/25/2012
- **Last updated:** 05/07/2015