MEDICARE: THE SOLACE CENTER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1629538525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SOLACE CENTER

Provider Business Mailing Address
First Line	:	9701 APOLLO DR STE 461
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-6701
Country	:	US
Telephone Number	:	240-714-3560
Fax Number	:	240-714-3561

Provider Business Practice Location Address
First Line	:	9701 APOLLO DR STE 461
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-6701
Country	:	US
Telephone Number	:	240-714-3560
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHAWANA TORRENCE
Credential	:
Telephone Number	:	336-471-8130

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	03/25/2019

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Directions to “THE SOLACE CENTER ” Practice Location

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