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General NPI Number Information
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NPI Number | 1679073829
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Entity Type | Organization
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Legal Business Name | SANCTUARY, LLC
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 3220 W 57TH ST STE 103
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City | SIOUX FALLS
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State | SD
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Zip | 57108-3146
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Country | US
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Telephone | 507-360-9426
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Fax | 507-291-7474
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Provider Business Mailing Address
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Address Line | 921 4TH AVE
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City | WORTHINGTON
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State | MN
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Zip | 56187-2372
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Country | US
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Telephone | 507-360-9426
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Fax | 507-291-7474
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ANDREA WALKER
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Credential | MS, LMFT
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Telephone | 507-360-9426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT11500
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License Number State | SD
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