Healthcare Provider Details

I. General information

NPI: 1750205589
Provider Name (Legal Business Name): SANCTUARY THERAPY & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 EDGEWATER DR STE 1278
ORLANDO FL
32804-6350
US

IV. Provider business mailing address

1317 EDGEWATER DR STE 1278
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 813-773-2464
  • Fax:
Mailing address:
  • Phone: 813-773-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOANNA HEATHER PEREZ
Title or Position: SOLE MEMBER
Credential: LMHC
Phone: 813-773-2464