Healthcare Provider Details

I. General information

NPI: 1689502981
Provider Name (Legal Business Name): MY SANCTUARY MENTAL HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5886 IMPERIAL DR
FREDERICK MD
21703-2962
US

IV. Provider business mailing address

5886 IMPERIAL DR
FREDERICK MD
21703-2962
US

V. Phone/Fax

Practice location:
  • Phone: 301-673-2975
  • Fax:
Mailing address:
  • Phone: 301-673-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELEONOR M CABRERA
Title or Position: OWNER/ CLINICAL SOCIAL WORKER
Credential: LCSW-C
Phone: 301-673-2975