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General NPI Number Information
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NPI Number | 1801668488
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Entity Type | Organization
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Legal Business Name | SOLACE SYSTEM GROUP LLC
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 141 N MAIN ST
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City | BEL AIR
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State | MD
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Zip | 21014-3576
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Country | US
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Telephone | 443-798-0433
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Fax |
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Provider Business Mailing Address
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Address Line | 535 STRATFORD RD
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City | FALLSTON
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State | MD
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Zip | 21047-2913
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Country | US
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Telephone | 443-798-0433
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CORDIA ELIZABETH GRANDEA
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Credential | LCPC
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Telephone | 443-798-0433
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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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