| Sacred Spaces Counseling, Llc | |
|
8825 Perimeter Park Blvd Ste 601 Jacksonville FL 32216-1122 | |
| (904) 885-0724 | |
| (904) 409-3464 |
| Full Name | Sacred Spaces Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 8825 Perimeter Park Blvd Ste 601, Jacksonville, Florida |
| Authorized Official Name and Position | Teresa Ann Moore (OWNER/THERAPIST) |
| Authorized Official Contact | 9048850724 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Spaces Counseling, Llc 8825 Perimeter Park Blvd Ste 601 Jacksonville FL 32216-1122 Ph: (904) 885-0724 | Sacred Spaces Counseling, Llc 8825 Perimeter Park Blvd Ste 601 Jacksonville FL 32216-1122 Ph: (904) 885-0724 |
| NPI Number | 1093309361 |
|---|---|
| Provider Enumeration Date | 02/26/2021 |
| Last Update Date | 02/26/2021 |
| Certification Date | 02/25/2021 |
| Medicare PECOS PAC ID | 5496155160 |
|---|---|
| Medicare Enrollment ID | O20210617000441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093309361 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Teresa Ann Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558840058 PECOS PAC ID: 6305246075 Enrollment ID: I20210617000592 |
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