Sovereign Body of Love Healing Center, LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SOVEREIGN BODY OF LOVE HEALING CENTER, LLC

Practice address

3409 N Holland Sylvania Rd
Toledo, OH 43615-1411

Phone

(567) 297-0008

NPI assigned

Sep 20, 2024

Organization subpart

No

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

Authorized official

Name

Ms. Latrice Marie Waddell, MSN, PMHCNS-BCNPI 1316375124

Title

Advanced Practice Registered Nurse

Phone

(419) 508-9937

Specialties & licenses 1

Addresses

Practitioners 1

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

• Latrice Waddell, CNS-PMH

  • Adult Psychiatric/Mental Health Clinical Nurse Specialist
  • Toledo, OH
  • NPI 1316375124
  NPD Authorized official

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1962229039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1970 DEVINCI DR",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436153373",
            "telephone_number": "419-508-9937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 N HOLLAND SYLVANIA RD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436151411",
            "telephone_number": "567-297-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN BODY OF LOVE HEALING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-20",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "LATRICE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ADVANCED PRACTICE REGISTERED NURSE",
        "authorized_official_telephone_number": "419-508-9937",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSN, PMHCNS-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aniah Southall
• Erik Oliver Southard
• Amber Southward
• Makayla Souva
• Stephanie Ann Souza, LSW
• Sovereign Solutions, LLC
• Breonna Sowell
• Amy Spacht
• Kelsey Lee Spacht
• Connie Therese Spahn, CNP

• Psychiatric/Mental Health Nurse Practitioner in Toledo, OH
• Providers in Toledo, OH by specialty
• Psychiatric/Mental Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; 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.