Provider Demographics
NPI:1861762833
Name:SACRED GROUND, LLC
Entity type:Organization
Organization Name:SACRED GROUND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CORMIER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW, MDIV
Authorized Official - Phone:484-529-3856
Mailing Address - Street 1:61 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1698
Mailing Address - Country:US
Mailing Address - Phone:484-529-3856
Mailing Address - Fax:
Practice Address - Street 1:1291 READING AVE
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-8186
Practice Address - Country:US
Practice Address - Phone:484-529-3856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW007093L251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health