Provider Demographics
NPI:1639728827
Name:SANCTUARY THERAPEUTIC COUNSELING SERVICES
Entity Type:Organization
Organization Name:SANCTUARY THERAPEUTIC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAFIYAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW MCAP CRRA
Authorized Official - Phone:862-237-8088
Mailing Address - Street 1:218 NE 51ST ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2871
Mailing Address - Country:US
Mailing Address - Phone:862-237-8088
Mailing Address - Fax:
Practice Address - Street 1:3246 N. MIAMI AVENUE SUITE A
Practice Address - Street 2:#370585
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127
Practice Address - Country:US
Practice Address - Phone:862-237-8088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty