Healthcare Provider Details

I. General information

NPI: 1578467411
Provider Name (Legal Business Name): SOAR FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MONAGAN ST
FAYETTEVILLE NC
28301-7024
US

IV. Provider business mailing address

272 PARADISE DR
PORTSMOUTH VA
23701-2742
US

V. Phone/Fax

Practice location:
  • Phone: 813-380-0228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEXIS THOMAS
Title or Position: DIRECTOR
Credential:
Phone: 813-380-0228