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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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