Healthcare Provider Details

I. General information

NPI: 1184548505
Provider Name (Legal Business Name): THAIS IRINA WILSON-SOLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 BROADWAY STE 2125
NEW YORK NY
10018-9228
US

IV. Provider business mailing address

1412 BROADWAY STE 2125
NEW YORK NY
10018-9228
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-5880
  • Fax:
Mailing address:
  • Phone: 828-318-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: