Organization
SOARING ON SUCCESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWAYNE LEE GIBSON JR. MSW (CEO)
(419) 705-8682
Entity
Organization
Contact information
Practice address
2146 N 13TH ST, TOLEDO, OH 43620-1909
(419) 705-8682
Mailing address
2146 N 13TH ST, TOLEDO, OH 43620-1909
(419) 705-8682
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/03/2019
Last updated
10/03/2019
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