Organization
JEANETTES SANCTUARY LLC
Active
Organization
JEANETTES SANCTUARY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LATASHA MONIQUE GORDON LPC, LICDC, OCPSA (FOUNDER/CEO)
(440) 657-6446
Entity
Organization
Contact information
Practice address
38780 CHESTNUT RIDGE RD, ELYRIA, OH 44035-8232
(440) 219-4004
Mailing address
113 LEXINGTON AVE, ELYRIA, OH 44035-6217
(440) 657-6446
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/20/2025
Last updated
03/20/2025
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