Provider Demographics
NPI:1639756794
Name:THE SAFE SPACE THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:THE SAFE SPACE THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-980-7301
Mailing Address - Street 1:2215 PLANK RD # 126
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5226
Mailing Address - Country:US
Mailing Address - Phone:540-987-0362
Mailing Address - Fax:855-364-3944
Practice Address - Street 1:1125 JEFFERSON DAVIS HWY STE 400
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8449
Practice Address - Country:US
Practice Address - Phone:540-987-0362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty