Provider Demographics
NPI:1841171949
Name:SECOND MILE ENTERPRISE - DBA:SOMA THERAPY & WELLNESS
Entity type:Organization
Organization Name:SECOND MILE ENTERPRISE - DBA:SOMA THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-204-1683
Mailing Address - Street 1:1503 COLLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1764
Mailing Address - Country:US
Mailing Address - Phone:757-204-1683
Mailing Address - Fax:757-299-8143
Practice Address - Street 1:1503 COLLEY AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1764
Practice Address - Country:US
Practice Address - Phone:757-204-1683
Practice Address - Fax:757-299-8143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty