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General NPI Number Information
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NPI Number | 1710381579
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Entity Type | Organization
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Legal Business Name | SOAR COUNSELING SERVICES
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 117 S. MARION ST. SUITE E
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City | ATHENS
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State | AL
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Zip | 35611-2552
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Country | US
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Telephone | 256-278-4364
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Fax |
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Provider Business Mailing Address
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Address Line | 117 S MARION ST STE E
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City | ATHENS
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State | AL
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Zip | 35611-2552
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Country | US
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Telephone | 256-278-4364
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | LISA WOLANZYK
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Credential | LCSW
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Telephone | 256-278-4364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2351C
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License Number State | AL
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