Provider Demographics
NPI:1790310159
Name:SANCTUARY COMMUNITY COUNSELING AND RESOURCES, NFP
Entity Type:Organization
Organization Name:SANCTUARY COMMUNITY COUNSELING AND RESOURCES, NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:REESE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:773-717-9921
Mailing Address - Street 1:12247 S RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60643-5401
Mailing Address - Country:US
Mailing Address - Phone:312-687-0198
Mailing Address - Fax:
Practice Address - Street 1:12247 S RACINE AVE
Practice Address - Street 2:
Practice Address - City:CALUMET PARK
Practice Address - State:IL
Practice Address - Zip Code:60643-5401
Practice Address - Country:US
Practice Address - Phone:312-687-0198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANCTUARY COUNSELING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No282J00000XHospitalsReligious Nonmedical Health Care InstitutionGroup - Multi-Specialty