Organization
SACRED SPACE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA J BLEA JOHNSON LCSW, LADAC (OWNER)
(505) 259-1737
Entity
Organization
Contact information
Practice address
2445 IRIS RD NW, ALBUQUERQUE, NM 87104-3008
(505) 259-1737
(505) 448-7925
Mailing address
PO BOX 70112, ALBUQUERQUE, NM 87197-0112
(505) 259-1737
(505) 448-7925
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/02/2023
Last updated
04/20/2024
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