Organization
SOLOMON PORCH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ROOT LPC, PSYD (SOLE MEMBER)
(907) 350-4353
Entity
Organization
Contact information
Practice address
626 2ND ST STE 101, FAIRBANKS, AK 99701-3466
(907) 350-4353
Mailing address
626 2ND ST STE 101, FAIRBANKS, AK 99701-3466
(907) 350-4353
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
101191
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10031301
ALASKA ENTITY
AK
Enumeration date
08/07/2015
Last updated
08/07/2015
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