Healthcare Provider Details

I. General information

NPI: 1982105664
Provider Name (Legal Business Name): SURVIVING OUR LOSSES AND CONTINUING EVERYDAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 6TH ST
PORTSMOUTH OH
45662-4030
US

IV. Provider business mailing address

729 6TH ST
PORTSMOUTH OH
45662-4030
US

V. Phone/Fax

Practice location:
  • Phone: 740-876-8290
  • Fax: 740-529-1205
Mailing address:
  • Phone: 740-876-8290
  • Fax: 740-529-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number13768
License Number StateOH

VIII. Authorized Official

Name: MICHAEL FRAULINI
Title or Position: EXECUTIVE DIRECTOR
Credential: LICDC-CS
Phone: 740-876-8290