Provider Demographics
NPI:1811872807
Name:FOURTH SPACE WELLNESS, P.L.L.C.
Entity type:Organization
Organization Name:FOURTH SPACE WELLNESS, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SEEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-315-7197
Mailing Address - Street 1:497 HOOKSETT RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2698
Mailing Address - Country:US
Mailing Address - Phone:603-945-0865
Mailing Address - Fax:603-782-9328
Practice Address - Street 1:497 HOOKSETT RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2698
Practice Address - Country:US
Practice Address - Phone:603-945-0865
Practice Address - Fax:603-782-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)