Organization
SOLACE WELLNESS MANAGEMENT SERVICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EZEKIEL JOHNSON SR. (EXECUTIVE DIRECTOR)
(480) 704-4707
Entity
Organization
Contact information
Practice address
4203 S 37TH ST, PHOENIX, AZ 85040-1813
(480) 704-4707
Mailing address
4203 S 37TH ST, PHOENIX, AZ 85040-1813
(480) 704-4707
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Enumeration date
10/25/2012
Last updated
05/07/2015
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