Healthcare Provider Details

I. General information

NPI: 1467361543
Provider Name (Legal Business Name): SACRED SPACE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WINDEMERE HTS
LACONIA NH
03246-1644
US

IV. Provider business mailing address

65 WINDEMERE HTS
LACONIA NH
03246-1644
US

V. Phone/Fax

Practice location:
  • Phone: 800-203-0502
  • Fax:
Mailing address:
  • Phone:
  • 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: MELISSA DOTEN
Title or Position: THERAPIST
Credential: LICSW
Phone: 774-263-1834