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General NPI Number Information
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NPI Number | 1922858323
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Entity Type | Organization
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Legal Business Name | SOTERIA COUNSELING PLLC
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1455 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-2934
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Country | US
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Telephone | 901-462-4747
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Fax | 901-276-0225
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Provider Business Mailing Address
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Address Line | 5516 HERITAGE LAKE COVE
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City | MEMPHIS
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State | TN
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Zip | 38109
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Country | US
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Telephone | 901-605-0768
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Fax |
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Authorized Official
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Title or Position | CEO/THERAPIST
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Name | MR. JOHN CLARK CANNON
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Credential | LCSW
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Telephone | 901-462-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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