| Sacred Space An Integrative Wellness Community | |
|
445 Little East Neck Rd West Babylon NY 11704-6543 | |
| (516) 265-2983 | |
| Not Available |
| Full Name | Sacred Space An Integrative Wellness Community |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 445 Little East Neck Rd, West Babylon, New York |
| Authorized Official Name and Position | Jennifer Marie Hairston-davis (LCSW-R) |
| Authorized Official Contact | 5162652983 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Space An Integrative Wellness Community 405 Marine Ln West Babylon NY 11704-8208 Ph: (516) 265-2983 | Sacred Space An Integrative Wellness Community 445 Little East Neck Rd West Babylon NY 11704-6543 Ph: (516) 265-2983 |
| NPI Number | 1922606896 |
|---|---|
| Provider Enumeration Date | 10/13/2020 |
| Last Update Date | 10/13/2020 |
| Certification Date | 10/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922606896 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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