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General NPI Number Information
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NPI Number | 1497629695
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Entity Type | Organization
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Legal Business Name | SOLACE GROVE PSYCHOTHERAPY
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 6325 WOODSIDE CT
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City | COLUMBIA
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State | MD
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Zip | 21046-1017
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Country | US
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Telephone | 410-886-6202
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Fax |
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Provider Business Mailing Address
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Address Line | 6325 WOODSIDE CT
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City | COLUMBIA
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State | MD
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Zip | 21046-1017
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Country | US
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Telephone | 410-886-6202
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PSYCHOLOGIST
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Name | DR. JACOB ALEXANDER MOORE
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Credential | PH.D.
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Telephone | 301-272-5080
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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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