Healthcare Provider Details

I. General information

NPI: 1962313569
Provider Name (Legal Business Name): SANKOFA HEALING HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 COLONIAL TER
EAST ORANGE NJ
07017-2104
US

IV. Provider business mailing address

33 COLONIAL TER
EAST ORANGE NJ
07017-2104
US

V. Phone/Fax

Practice location:
  • Phone: 973-393-0312
  • Fax:
Mailing address:
  • Phone: 973-393-0312
  • 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: LYNNE CHANTEL HOLLEY
Title or Position: CEO
Credential: LCSW
Phone: 973-393-0312