Provider Demographics
NPI:1730744426
Name:SOLASTA COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SOLASTA COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:STAIB
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:517-745-3659
Mailing Address - Street 1:3811 BIRNWICK DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-9217
Mailing Address - Country:US
Mailing Address - Phone:517-745-3659
Mailing Address - Fax:
Practice Address - Street 1:127 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2623
Practice Address - Country:US
Practice Address - Phone:517-745-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty