Healthcare Provider Details

I. General information

NPI: 1407750250
Provider Name (Legal Business Name): SOLACE CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 POST OFFICE RD STE 1C
WALDORF MD
20602-1912
US

IV. Provider business mailing address

601 POST OFFICE RD STE 1C
WALDORF MD
20602-1912
US

V. Phone/Fax

Practice location:
  • Phone: 301-485-6075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LANDON ZACKERY
Title or Position: MANAGER
Credential:
Phone: 301-485-6075