Sacred Space, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SACRED SPACE, LLC

Practice address

19310 Sherwood Green Way
Gaithersburg, MD 20879

Phone

(202) 567-7726

NPI assigned

Dec 31, 2020

Organization subpart

No

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

Authorized official

Name

Arielle Mesa, LICSW RYT

Title

Clinical Social Worker

Phone

(202) 265-1000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1609372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609372800000",
    "number": "1679160063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 ELLINGTON BLVD # 171",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208784591",
            "telephone_number": "202-567-7726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19310 SHERWOOD GREEN WAY",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "20879",
            "telephone_number": "202-567-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED SPACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-31",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "MESA",
        "authorized_official_first_name": "ARIELLE",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "202-265-1000",
        "authorized_official_credential": "LICSW RYT"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; 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.