Healthcare Provider Details

I. General information

NPI: 1992183735
Provider Name (Legal Business Name): SOTERIA ENTERPRISES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 SPRING ARBOR RD STE 300
JACKSON MI
49203-3652
US

IV. Provider business mailing address

2575 SPRING ARBOR RD STE 300
JACKSON MI
49203-3652
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-8330
  • Fax: 517-788-9768
Mailing address:
  • Phone: 517-788-8330
  • Fax: 517-788-9768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801059321
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number6801059321
License Number StateMI

VIII. Authorized Official

Name: PHILIP RAYMOND BARKER
Title or Position: SOLE PROPRIETOR
Credential: LMSW, ACSW, SSW
Phone: 517-488-2077