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General NPI Number Information
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NPI Number | 1467100883
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Entity Type | Organization
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Legal Business Name | SOAR & LIVE INC
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 517 N MOUNTAIN AVE # 216
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City | UPLAND
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State | CA
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Zip | 91786-5016
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Country | US
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Telephone | 909-401-1759
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Fax | 866-927-8001
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Provider Business Mailing Address
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Address Line | 517 N MOUNTAIN AVE # 216
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City | UPLAND
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State | CA
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Zip | 91786-5016
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Country | US
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Telephone | 909-401-1759
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Fax | 866-927-8001
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. CHERISSE HUNTER-SOUTHERN
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Credential | ED.D. COUNSELING PSY
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Telephone | 909-401-1759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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