Provider Demographics
NPI:1205541869
Name:SANCTUARY MENTAL HEALTH COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:SANCTUARY MENTAL HEALTH COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAHLEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, RPT, CCPT
Authorized Official - Phone:315-289-2504
Mailing Address - Street 1:333 ASHDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-1605
Mailing Address - Country:US
Mailing Address - Phone:315-289-2504
Mailing Address - Fax:
Practice Address - Street 1:333 ASHDALE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-1605
Practice Address - Country:US
Practice Address - Phone:315-289-2504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty