Soul Sanctuary, LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

SOUL SANCTUARY, LLC

Practice address

1519 Forest Ave
Portland, ME 04103-1805

Phone

(617) 690-9020

NPI assigned

Apr 5, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Nashawaty

Title

Program Director

Phone

(617) 690-9020

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1003557943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 REDLON RD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022218",
            "telephone_number": "617-690-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 FOREST AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041031805",
            "telephone_number": "617-690-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL SANCTUARY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "NASHAWATY",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "617-690-9020"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Sortwell, M.D.
• Lora Soucy Moreau, OTR/L
• Ashley Dawn Soucy, LD
• Jacob W Soucy, PA-S
• Jennifer Anne Soucy, PHARMD
• Helen M Soule, MD
• Soundings Therapy Group, PLLC
• Jordan Kelly Sountis, AGACNP
• Sydney Marie Sousa, PA-C
• Sarah Chisholm Southard, A.N.P.

• Addiction (Substance Use Disorder) Counselor in Portland, ME
• Providers in Portland, ME by specialty
• Addiction (Substance Use Disorder) Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.