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General NPI Number Information
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NPI Number | 1780196972
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Entity Type | Organization
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Legal Business Name | SOBER LIFE COACH LLC
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Dates
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Enumeration Date | 10/29/2017
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Last Update Date | 10/29/2017
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Provider Practice Location Address
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Address Line | 6757 FRIARS RD UNIT 14
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City | SAN DIEGO
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State | CA
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Zip | 92108-5013
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Country | US
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Telephone | 619-674-3501
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Fax |
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Provider Business Mailing Address
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Address Line | 6757 FRIARS RD UNIT 14
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City | SAN DIEGO
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State | CA
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Zip | 92108-5013
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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 | COUNSELLOR
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Name | ROMAN BRALY
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Credential | CADC II
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Telephone | 619-674-3501
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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 | A042941116
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | A042941116
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | A042941116
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License Number State | CA
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