Healthcare Provider Details

I. General information

NPI: 1346869682
Provider Name (Legal Business Name): SOMA LOTUS EXECUTIVE COACHING COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 CENTER RIDGE RD STE 621
ROCKY RIVER OH
44116-3554
US

IV. Provider business mailing address

6303 RIDGEWOOD AVE
PARMA OH
44129-2325
US

V. Phone/Fax

Practice location:
  • Phone: 216-505-1391
  • Fax:
Mailing address:
  • Phone: 216-832-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANYCIA GRADY
Title or Position: OWNER/ CLINICAL SOCIAL WORKER
Credential: MSSA, LISW-S
Phone: 216-505-1391