| NPI | 1164118642 |
|---|---|
| Former Legal Business Name | SANE SPACE LLC |
| Doing Business As | SANE SPACE |
| Entity Type | Organization |
| Authorized Contact | CHRISTINA JACKSON Owner 304-220-0041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2023-10-19 |