# SOVEREIGN BODY OF LOVE HEALING CENTER, LLC

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

## Provider details

- **NPI number:** 1962229039
- **Authorized official:** MS. LATRICE MARIE WADDELL MSN, PMHCNS-BC (ADVANCED PRACTICE REGISTERED NURSE)
- **Authorized official phone:** (419) 508-9937

## Contact information

- **Practice address:** 3409 N HOLLAND SYLVANIA RD, TOLEDO, OH 43615-1411
- **Practice address phone:** (567) 297-0008
- **Mailing address:** 1970 DEVINCI DR, TOLEDO, OH 43615-3373
- **Mailing address phone:** (419) 508-9937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2024
- **Last updated:** 09/20/2024