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General NPI Number Information
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NPI Number | 1467361543
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Entity Type | Organization
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Legal Business Name | SACRED SPACE COUNSELING PLLC
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 65 WINDEMERE HTS
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City | LACONIA
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State | NH
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Zip | 03246-1644
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Country | US
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Telephone | 800-203-0502
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Fax |
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Provider Business Mailing Address
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Address Line | 65 WINDEMERE HTS
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City | LACONIA
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State | NH
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Zip | 03246-1644
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MELISSA DOTEN
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Credential | LICSW
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Telephone | 774-263-1834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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