Healthcare Provider Details

I. General information

NPI: 1013870922
Provider Name (Legal Business Name): SACRED SPACE COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 E MARKET ST STE 106
AKRON OH
44305-2460
US

IV. Provider business mailing address

839 E MARKET ST STE 106
AKRON OH
44305-2460
US

V. Phone/Fax

Practice location:
  • Phone: 330-990-2007
  • Fax: 330-990-2007
Mailing address:
  • Phone: 330-990-2007
  • Fax: 330-990-2007

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: CONSTANCE SALES
Title or Position: OWNER
Credential: LISW-S
Phone: 330-990-2007