Sacred Space Counseling and Wellness LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

SACRED SPACE COUNSELING AND WELLNESS LLC

Practice address

46 Lebanon Rd
Bozrah, CT 06334-1116

Phone

(860) 617-4082

Fax

(860) 617-4082

NPI assigned

Jan 13, 2018

Last updated

Jan 13, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Heather Bonitz-Moore, ATR-BC, LPC, IMH-ENPI 1821165788

Title

Art Therapist, Owner

Phone

(860) 617-4082

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Heather Jo Bonitz-Moore, ATR-BC, LPC, IMH-E

  • Professional Counselor
  • Bozrah, CT
  • NPI 1821165788
  NPD (past) Authorized official

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

{
    "created_epoch": "1515801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515801600000",
    "number": "1093223976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 FOWLER RD",
            "city": "LEBANON",
            "state": "CT",
            "postal_code": "062492503",
            "telephone_number": "860-617-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 LEBANON RD",
            "city": "BOZRAH",
            "state": "CT",
            "postal_code": "063341116",
            "telephone_number": "860-617-4082",
            "fax_number": "860-617-4082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED SPACE COUNSELING AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-13",
        "last_updated": "2018-01-13",
        "status": "A",
        "authorized_official_last_name": "BONITZ-MOORE",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "ART THERAPIST, OWNER",
        "authorized_official_telephone_number": "860-617-4082",
        "authorized_official_credential": "ATR-BC, LPC, IMH-E"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Bozrah, CT
• Providers in Bozrah, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2018; 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.