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General NPI Number Information
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NPI Number | 1770296824
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Entity Type | Organization
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Legal Business Name | THE SANCTUARY COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 103 HIGHTOWER RD
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City | HARVEST
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State | AL
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Zip | 35749-9111
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Country | US
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Telephone | 773-217-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 103 HIGHTOWER RD
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City | HARVEST
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State | AL
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Zip | 35749-9111
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Country | US
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Telephone | 773-217-6280
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LARRY DONELL LEWIS
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Credential |
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Telephone | 773-217-6280
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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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