=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902021785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOL PURPOSE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2760 CRAIN HWY SUITE 406
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20601-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-885-0992
-----------------------------------------------------
Fax | 301-885-0992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 127
-----------------------------------------------------
City | WALDORF
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20604-0127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-885-0992
-----------------------------------------------------
Fax | 301-885-0992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | MS. SONJA ROCHELLE BUCKLES
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 301-885-0992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LC2077
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------