Healthcare Provider Details

I. General information

NPI: 1790620854
Provider Name (Legal Business Name): SUI GENERIS SANCTUM SANCTORIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PERE ANTOINE ALY
NEW ORLEANS LA
70116-3234
US

IV. Provider business mailing address

4342 RUE DE BELLE MAISON APT D
BATON ROUGE LA
70809-7218
US

V. Phone/Fax

Practice location:
  • Phone: 225-333-4424
  • Fax:
Mailing address:
  • Phone: 225-333-4424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEA CHARRON HENTON
Title or Position: MASSARIUS
Credential: ACHE,MH,CHT
Phone: 225-333-4424