Provider Demographics
NPI:1255123915
Name:SOLACE LIFE CHANGE LLC
Entity type:Organization
Organization Name:SOLACE LIFE CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARLEEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:TCADC
Authorized Official - Phone:502-702-9366
Mailing Address - Street 1:2801 VIRGINIA AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-3418
Mailing Address - Country:US
Mailing Address - Phone:502-702-9366
Mailing Address - Fax:502-963-5938
Practice Address - Street 1:2801 VIRGINIA AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-3418
Practice Address - Country:US
Practice Address - Phone:502-702-9366
Practice Address - Fax:502-963-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty