Provider Demographics
NPI:1669013934
Name:A SPACE FOR HEALING, LLC
Entity Type:Organization
Organization Name:A SPACE FOR HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRAUMA THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VAVRO
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-413-4637
Mailing Address - Street 1:8500 STATION STREET
Mailing Address - Street 2:STE 300J
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5756
Mailing Address - Country:US
Mailing Address - Phone:407-218-9794
Mailing Address - Fax:
Practice Address - Street 1:8500 STATION ST STE 300J
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4963
Practice Address - Country:US
Practice Address - Phone:440-721-8979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health