Sacred Life Recovery Services

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

SACRED LIFE RECOVERY SERVICES

Practice address

2681 Lakeshore Blvd Apt 7
Lakeport, CA 95453-6971

Phone

(707) 295-2304

NPI assigned

Jul 26, 2024

Organization subpart

No

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

Authorized official

Name

Raevan Shepherd, SUDCCNPI 1053812883

Title

Counselor

Phone

(707) 295-2304

Specialties & licenses 1

Addresses

Other names 1

• Sacred Life Recovery Services Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raevan Monica Shepherd, ASW

  • Clinical Social Worker
  • Lower Lake, CA
  • NPI 1053812883

  Addiction (Substance Use Disorder)

  NPD Authorized official

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

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1750119061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 N MAIN ST STE 128",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954534809",
            "telephone_number": "707-295-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2681 LAKESHORE BLVD APT 7",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954536971",
            "telephone_number": "707-295-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED LIFE RECOVERY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-26",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "RAEVAN",
        "authorized_official_title_or_position": "COUNSELOR",
        "authorized_official_telephone_number": "707-295-2304",
        "authorized_official_credential": "SUDCC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sacred Life Recovery Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tammy Rogers
• Bernard Roseman, RX
• Nicolaus Gus Rosete, NP
• Diane Sigrid Rowe, PHARMD
• Johanna Ruiz, RN, PHN, MSN
• Alireza Sadre-Nassiri, D.M.D.
• Safeway Inc
• Michelle Sagehorn, REHAB SPECIALIST
• Shayaan Sajid
• Messina Salazar

• Addiction (Substance Use Disorder) Counselor in Lakeport, CA
• Providers in Lakeport, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.