Healthcare Provider Details

I. General information

NPI: 1235799842
Provider Name (Legal Business Name): SOLACE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 23RD ST S STE D
FARGO ND
58103-3724
US

IV. Provider business mailing address

1321 23RD ST S STE D
FARGO ND
58103-3724
US

V. Phone/Fax

Practice location:
  • Phone: 701-203-8725
  • Fax:
Mailing address:
  • Phone: 701-203-8725
  • Fax:

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY SCHANK
Title or Position: OWNER
Credential: LICSW
Phone: 701-412-3938