Organization
SOLACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAN F. SHERBAK PSYD (CLINICAL DIRECTOR/OWNER)
(423) 752-5207
Entity
Organization
Contact information
Practice address
3097 BROAD ST, CHATTANOOGA, TN 37408-3093
(423) 752-5207
(423) 752-5299
Mailing address
3097 BROAD ST, CHATTANOOGA, TN 37408-3093
(423) 752-5207
(423) 752-5299
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4055601
BCBS
TN
Enumeration date
04/19/2007
Last updated
01/28/2014
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