# SANCTUARY PSYCHOTHERAPY SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104563378
- **Authorized official:** MARIA WIBBELS LCSW (OWNER)
- **Authorized official phone:** (845) 274-4470

## Contact information

- **Practice address:** 5737 S WATTERSON TRL APT 5, LOUISVILLE, KY 40291-1899
- **Practice address phone:** (452) 744-4708
- **Practice address fax:** (502) 331-6062
- **Mailing address:** 5737 S WATTERSON TRL APT 5, LOUISVILLE, KY 40291-1899
- **Mailing address phone:** (845) 274-4470
- **Mailing address fax:** (502) 331-6062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 05/18/2022
- **Last updated:** 05/18/2022