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General NPI Number Information
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NPI Number | 1285267914
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Entity Type | Organization
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Legal Business Name | SODA VENTURES LLC. D.B.A. 92 REASONS
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 1332 TEASLEY LN STE 103A
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City | DENTON
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State | TX
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Zip | 76205-7946
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Country | US
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Telephone | 469-986-9629
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Fax | 469-453-3193
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Provider Business Mailing Address
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Address Line | 1332 TEASLEY LN STE 103A
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City | DENTON
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State | TX
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Zip | 76205-7946
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Country | US
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Telephone | 469-986-9629
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Fax | 469-453-3193
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | SOPHIA CANNON
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Credential | CRC, LPC
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Telephone | 469-986-9629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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