Provider Demographics
NPI:1568242535
Name:SACRED SPACE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:SACRED SPACE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHRATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:248-722-5304
Mailing Address - Street 1:171 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01985-1801
Mailing Address - Country:US
Mailing Address - Phone:248-722-5304
Mailing Address - Fax:
Practice Address - Street 1:171 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST NEWBURY
Practice Address - State:MA
Practice Address - Zip Code:01985-1801
Practice Address - Country:US
Practice Address - Phone:248-722-5304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty