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General NPI Number Information
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NPI Number | 1619533098
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Entity Type | Organization
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Legal Business Name | SANKOFA HEALING STUDIO
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Dates
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Enumeration Date | 05/11/2019
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 1415 N BROAD ST STE 102
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3324
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Country | US
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Telephone | 215-802-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 N BROAD ST STE 102
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3324
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Country | US
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Telephone | 215-802-3533
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JACQUELINE JOHNSON
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Credential | MS, LPC, ATR-BC
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Telephone | 215-802-3533
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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