Provider Demographics
NPI:1972247724
Name:SAFE SPACE THERAPY & CONSULTING LLC
Entity Type:Organization
Organization Name:SAFE SPACE THERAPY & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:256-578-7054
Mailing Address - Street 1:10243 LONG MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4225
Mailing Address - Country:US
Mailing Address - Phone:256-479-2944
Mailing Address - Fax:
Practice Address - Street 1:604 DAVIS CIR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5014
Practice Address - Country:US
Practice Address - Phone:256-578-7054
Practice Address - Fax:256-287-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health