| Soul Sanctuary, Llc | |
|
1519 Forest Ave Portland ME 04103-1805 | |
| (617) 690-9020 | |
| Not Available |
| Full Name | Soul Sanctuary, Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1519 Forest Ave, Portland, Maine |
| Authorized Official Name and Position | Lisa Nashawaty (PROGRAM DIRECTOR) |
| Authorized Official Contact | 6176909020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soul Sanctuary, Llc 22 Redlon Rd Portland ME 04102-2218 Ph: (617) 690-9020 | Soul Sanctuary, Llc 1519 Forest Ave Portland ME 04103-1805 Ph: (617) 690-9020 |
| NPI Number | 1003557943 |
|---|---|
| Provider Enumeration Date | 04/05/2022 |
| Last Update Date | 04/05/2022 |
| Certification Date | 04/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003557943 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
Catholic Charities Maine Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 307 Congress Street, Portland, ME 04101 Phone: 207-781-8550 Fax: 207-781-8560 | |
Dani Fazio Psychotherapy Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 57 Exchange St Ste 203, Portland, ME 04101 Phone: 207-618-6588 Fax: 207-203-6480 | |
Ingraham Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 50 Monument Sq, Portland, ME 04101 Phone: 207-874-1055 Fax: 207-774-5901 | |
Alliance Residential Care, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 58 Boyd St Apt 501, Portland, ME 04101 Phone: 860-710-6770 | |
Scrx-lifetransitions Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 222 Saint John St Ste 208, Portland, ME 04102 Phone: 207-891-8618 | |
Lauren Grousd Lcpc Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 440 Forest Ave, Portland, ME 04101 Phone: 207-650-8906 Fax: 207-221-2130 |