Healthcare Provider Details

I. General information

NPI: 1568268142
Provider Name (Legal Business Name): SOLACE CLINICAL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 CLIME RD
COLUMBUS OH
43228-3532
US

IV. Provider business mailing address

16169 OLD MANSFIELD RD
FREDERICKTOWN OH
43019-9604
US

V. Phone/Fax

Practice location:
  • Phone: 740-507-0606
  • Fax:
Mailing address:
  • Phone: 740-507-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HALEY MCCOY
Title or Position: OWNER/COUNSELOR
Credential: LISW-S
Phone: 740-507-0606