Healthcare Provider Details

I. General information

NPI: 1700748969
Provider Name (Legal Business Name): SOVEREIGN THERAPY & RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N MIRANDA ST APT B3
LAS CRUCES NM
88005-2063
US

IV. Provider business mailing address

1155 N MIRANDA ST APT B3
LAS CRUCES NM
88005-2063
US

V. Phone/Fax

Practice location:
  • Phone: 413-320-8916
  • Fax:
Mailing address:
  • Phone: 413-320-8916
  • 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: JUSTIN WILLIAM MARSH
Title or Position: OWNER
Credential: LMSW
Phone: 413-320-8916