Healthcare Provider Details

I. General information

NPI: 1063963718
Provider Name (Legal Business Name): SOLID SOBRIETY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6345
US

IV. Provider business mailing address

721 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6345
US

V. Phone/Fax

Practice location:
  • Phone: 954-783-8300
  • Fax: 954-783-8302
Mailing address:
  • Phone: 954-783-8300
  • Fax: 954-783-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JONATHAN SOBELMAN
Title or Position: OWNER/CEO
Credential:
Phone: 954-655-6735