Healthcare Provider Details

I. General information

NPI: 1942132758
Provider Name (Legal Business Name): THE SACRED LOUNGE SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7406 PEBBLE PT
WEST BLOOMFIELD MI
48322-3516
US

IV. Provider business mailing address

7406 PEBBLE PT
WEST BLOOMFIELD MI
48322-3516
US

V. Phone/Fax

Practice location:
  • Phone: 313-655-0929
  • Fax:
Mailing address:
  • Phone: 313-655-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: LASHANTA ERICKA MITCHELL
Title or Position: DOULA
Credential:
Phone: 313-655-0929