Provider Demographics
NPI:1467026286
Name:SAFE SPACE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:SAFE SPACE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERNETHY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-223-5084
Mailing Address - Street 1:2311 W CONE BLVD STE 236
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4062
Mailing Address - Country:US
Mailing Address - Phone:336-223-5084
Mailing Address - Fax:
Practice Address - Street 1:2311 W CONE BLVD STE 236
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4062
Practice Address - Country:US
Practice Address - Phone:336-223-5084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty