Healthcare Provider Details

I. General information

NPI: 1053125146
Provider Name (Legal Business Name): SACRED SPACE HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 MOUNTAIN RD NW
ALBUQUERQUE NM
87102-2070
US

IV. Provider business mailing address

4010 CARLISLE BLVD NE STE F
ALBUQUERQUE NM
87107-4532
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-0423
  • Fax:
Mailing address:
  • Phone: 505-414-0423
  • 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: ALEXANDRIA NICOLE RUBIO
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 505-414-0423