Provider Demographics
NPI:1730967498
Name:SACRED SPIRIT COUNSELING AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SACRED SPIRIT COUNSELING AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAZINAKIS-SWAINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-350-6600
Mailing Address - Street 1:6278 JOHN MUIR TRL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80927-4161
Mailing Address - Country:US
Mailing Address - Phone:727-698-3804
Mailing Address - Fax:
Practice Address - Street 1:6278 JOHN MUIR TRL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80927-4161
Practice Address - Country:US
Practice Address - Phone:727-698-3804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty