Provider Demographics
NPI:1528822178
Name:THE PLACE TO HEAL LLC
Entity type:Organization
Organization Name:THE PLACE TO HEAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CIARA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:SUROS
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, LCSWA, CSI
Authorized Official - Phone:803-306-2458
Mailing Address - Street 1:136 CARBONTON RD STE 118
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4000
Mailing Address - Country:US
Mailing Address - Phone:803-306-2458
Mailing Address - Fax:472-202-4636
Practice Address - Street 1:136 CARBONTON RD STE 118
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4000
Practice Address - Country:US
Practice Address - Phone:803-306-2458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty