Organization
SOULSPACE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARIAH FAIRLEY LPC (OWNER)
(860) 941-4743
Entity
Organization
Contact information
Practice address
28 ROSELEAH DR, WATERFORD, CT 06385-4310
(860) 941-4743
(860) 941-4743
Mailing address
28 ROSELEAH DR, WATERFORD, CT 06385-4310
(860) 941-4743
(860) 941-4743
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
07/31/2024
Last updated
08/04/2024
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