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General NPI Number Information
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NPI Number | 1184099301
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Entity Type | Organization
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Legal Business Name | SOLOMON'S PROMISE
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 401 S HICKS ST
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-2115
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Country | US
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Telephone | 434-774-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 401 S HICKS ST
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-2115
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Country | US
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Telephone | 434-774-6191
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Fax |
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Authorized Official
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Title or Position | LICENSED SOCIAL WORKER
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Name | ELAINE COLE
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Credential | LCSW
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Telephone | 434-774-6191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0904001968
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License Number State | VA
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