Provider Demographics
NPI:1649010877
Name:SAFE RETREAT MENTAL HEALTH
Entity type:Organization
Organization Name:SAFE RETREAT MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AFSHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KHALID
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH
Authorized Official - Phone:302-765-7068
Mailing Address - Street 1:3301 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2052
Mailing Address - Country:US
Mailing Address - Phone:302-765-7068
Mailing Address - Fax:
Practice Address - Street 1:3301 GREEN ST
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2052
Practice Address - Country:US
Practice Address - Phone:302-765-7068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-27
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)