Provider Demographics
NPI:1891597845
Name:SOLUM, GEORGIA LEA (LCDC-I)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:LEA
Last Name:SOLUM
Suffix:
Gender:
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-2674
Mailing Address - Country:US
Mailing Address - Phone:806-476-8314
Mailing Address - Fax:
Practice Address - Street 1:1301 SW 15TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2674
Practice Address - Country:US
Practice Address - Phone:806-476-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69153101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)