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Organization
SACRED SPACE COUNSELING, LLC
Active
Organization
SACRED SPACE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORIEN MAGNUS (CEO)
(706) 248-0809
Entity
Organization
Contact information
Practice address
1509 JOHNSON FERRY RD STE T4-A, MARIETTA, GA 30062-8105
(706) 248-0809
Mailing address
3120 LAKERIDGE DR SE, MARIETTA, GA 30067-5464
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891227542
—
GA
Enumeration date
05/20/2021
Last updated
05/20/2021
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