Healthcare Provider Details

I. General information

NPI: 1073299541
Provider Name (Legal Business Name): SOUTHERN TRINITY THERAPEUTIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 CEDAR SPRINGS RD STE 300
DALLAS TX
75219-2600
US

IV. Provider business mailing address

PO BOX 764544
DALLAS TX
75376-4544
US

V. Phone/Fax

Practice location:
  • Phone: 469-987-3199
  • Fax:
Mailing address:
  • Phone: 214-717-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAPHNE JONES
Title or Position: OWNER/CHIEF EXECUTIVE OFFICER
Credential: M.ED., MA., ED.D
Phone: 469-987-3199