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General NPI Number Information
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NPI Number | 1336912286
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Entity Type | Organization
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Legal Business Name | THE HEALING SPACE LLC
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 11 S MAIN ST STE 200
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City | CONCORD
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State | NH
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Zip | 03301-4846
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Country | US
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Telephone | 781-513-1577
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Fax |
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Provider Business Mailing Address
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Address Line | 11 S MAIN ST STE 200
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City | CONCORD
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State | NH
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Zip | 03301-4846
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Country | US
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Telephone | 781-513-1577
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA SADAT
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Credential | PMHNP-BC
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Telephone | 603-714-9474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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