MEDICARE: SOLACE LIFE CHANGE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	104100000X	Social Worker
3	101YP2500X	Professional Counselor
4	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1255123915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLACE LIFE CHANGE LLC

Provider Business Mailing Address
First Line	:	2801 VIRGINIA AVE UNIT 2
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-3418
Country	:	US
Telephone Number	:	502-963-5677
Fax Number	:	502-963-5591

Provider Business Practice Location Address
First Line	:	2801 VIRGINIA AVE UNIT 2
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-3418
Country	:	US
Telephone Number	:	502-702-9366
Fax Number	:	502-963-5938

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	SHARLEEKA LEWIS
Credential	:
Telephone Number	:	502-963-5677

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	06/30/2026

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Directions to “SOLACE LIFE CHANGE LLC ” Practice Location

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