Provider Demographics
NPI:1447011333
Name:SOLACE OCDANXIETY THERAPY, PLLC
Entity type:Organization
Organization Name:SOLACE OCDANXIETY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ARIZZA
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:224-858-8424
Mailing Address - Street 1:12172 SOUTH RTE 47 PMB 158
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142
Mailing Address - Country:US
Mailing Address - Phone:224-858-8424
Mailing Address - Fax:
Practice Address - Street 1:12172 S RTE 47 #158
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:224-858-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty