Provider Demographics
NPI:1518505262
Name:SAFE AND AFFIRMATIVE COUNSELING, LICENSED CLINICAL SOCIAL WORKER, INC
Entity Type:Organization
Organization Name:SAFE AND AFFIRMATIVE COUNSELING, LICENSED CLINICAL SOCIAL WORKER, INC
Other - Org Name:SAFE AND AFFIRMATIVE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-824-3779
Mailing Address - Street 1:7555 N DEL MAR AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6880
Mailing Address - Country:US
Mailing Address - Phone:559-824-3779
Mailing Address - Fax:559-705-1936
Practice Address - Street 1:7555 N DEL MAR AVE STE 206
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6880
Practice Address - Country:US
Practice Address - Phone:559-824-3779
Practice Address - Fax:559-705-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800677527Medicaid