Organization
SOUL SANCTUARY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA NASHAWATY (PROGRAM DIRECTOR)
(617) 690-9020
Entity
Organization
Contact information
Practice address
1519 FOREST AVE, PORTLAND, ME 04103-1805
(617) 690-9020
Mailing address
22 REDLON RD, PORTLAND, ME 04102-2218
(617) 690-9020
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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