Healthcare Provider Details

I. General information

NPI: 1962163972
Provider Name (Legal Business Name): S.O.A.R. CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 BLUE SKY DR
OWINGS MILLS MD
21117-1741
US

IV. Provider business mailing address

18 BLUE SKY DR
OWINGS MILLS MD
21117-1741
US

V. Phone/Fax

Practice location:
  • Phone: 443-864-1069
  • Fax:
Mailing address:
  • Phone: 443-864-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RHONDA SIMON
Title or Position: CLINICAL SOCIAL WORKER
Credential: L.C.S.W.-C.
Phone: 443-864-1069