Sacred Earth Healing Village PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SACRED EARTH HEALING VILLAGE PLLC

Practice address

1451 S Elm Eugene St Ste 2308
Greensboro, NC 27406-2200

Phone

(336) 303-8421

Fax

(336) 464-2137

NPI assigned

Sep 23, 2025

Organization subpart

No

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

Authorized official

Name

Ms. Krystin Jherel Fullwood, LCMHCNPI 1629505599

Title

Owner

Phone

(336) 280-9976

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.

• Krystin Jherel Fullwood

  • Mental Health Counselor
  • Summerfield, NC
  • NPI 1629505599
  NPD Authorized official

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

{
    "created_epoch": "1758585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1578435103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 S ELM EUGENE ST STE 2308",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274062200",
            "telephone_number": "336-303-8421",
            "fax_number": "336-464-2137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 S ELM EUGENE ST STE 2308",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274062200",
            "telephone_number": "336-303-8421",
            "fax_number": "336-464-2137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED EARTH HEALING VILLAGE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-23",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A",
        "authorized_official_last_name": "FULLWOOD",
        "authorized_official_first_name": "KRYSTIN",
        "authorized_official_middle_name": "JHEREL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-280-9976",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• S&T Connections
• Sacred Womb Haven
• Matt Sadlik
• Dustin Sadlowski, LCSW, LCAS
• Jennifer B Sadock, DC
• Safe Recovery and Wellness LLC

• Mental Health Counselor in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; 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.