Provider Demographics
NPI:1710381579
Name:SOAR COUNSELING SERVICES
Entity type:Organization
Organization Name:SOAR COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLANZYK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:256-278-4364
Mailing Address - Street 1:117 S MARION ST STE E
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2552
Mailing Address - Country:US
Mailing Address - Phone:256-278-4364
Mailing Address - Fax:
Practice Address - Street 1:117 S. MARION ST. SUITE E
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2552
Practice Address - Country:US
Practice Address - Phone:256-278-4364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2351C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health