Healthcare Provider Details

I. General information

NPI: 1740884931
Provider Name (Legal Business Name): SOLACE MENTAL HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 RITCHIE HWY STE 15
SEVERNA PARK MD
21146-4130
US

IV. Provider business mailing address

811 RITCHIE HWY STE 15
SEVERNA PARK MD
21146-4130
US

V. Phone/Fax

Practice location:
  • Phone: 410-995-9993
  • Fax: 410-995-8702
Mailing address:
  • Phone: 410-995-9993
  • Fax: 410-995-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLY BARTZ
Title or Position: CO-OWNER
Credential: PMHNP
Phone: 443-791-9780