=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093677908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SACRED SELF-LOVE COUNSELING LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2025
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 336 LAFAYETTE AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11238-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-690-6313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 ASH ST APT 318
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07304-4336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-690-6313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CEKIRA BUSH-MIGUEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-419-8111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------