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General NPI Number Information
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NPI Number | 1285292961
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Entity Type | Organization
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Legal Business Name | S0LASTA INCORPORATED
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 56 GINGER DR
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City | LUMBERTON
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State | NJ
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Zip | 08048-4204
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Country | US
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Telephone | 609-746-0146
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Fax |
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Provider Business Mailing Address
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Address Line | 56 GINGER DR
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City | LUMBERTON
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State | NJ
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Zip | 08048-4204
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER MARTIN
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Credential |
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Telephone | 609-746-0146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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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 #7
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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 #8
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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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