MEDICARE: SOL COUNSELING AND WELLNESS STUDIO, LLC

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1356088868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOL COUNSELING AND WELLNESS STUDIO, LLC

Provider Business Mailing Address
First Line	:	312 S CEDROS AVE STE 300
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1943
Country	:	US
Telephone Number	:	760-741-9799
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 S CEDROS AVE STE 300
Second Line	:
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-1943
Country	:	US
Telephone Number	:	760-741-9799
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. REBECCA JACKSON
Credential	:
Telephone Number	:	858-336-5049

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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