MEDICARE: SOLACE PSYCHOLOGY AND CONSULTING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1316574031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLACE PSYCHOLOGY AND CONSULTING PLLC

Provider Business Mailing Address
First Line	:	8225 MERRYVALE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-2659
Country	:	US
Telephone Number	:	828-222-6048
Fax Number	:

Provider Business Practice Location Address
First Line	:	8225 MERRYVALE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-2659
Country	:	US
Telephone Number	:	828-222-6048
Fax Number	:	828-484-1976

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. TONI LEE WYRICK
Credential	:	PH.D.
Telephone Number	:	828-222-6048

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	05/14/2026

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