Provider Demographics
NPI:1720855778
Name:THE SAFE SPACE, LLC
Entity Type:Organization
Organization Name:THE SAFE SPACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMYNYQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-660-3157
Mailing Address - Street 1:23 E WALKER RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4046
Mailing Address - Country:US
Mailing Address - Phone:757-660-3157
Mailing Address - Fax:
Practice Address - Street 1:809 ABERDEEN RD UNIT 9626
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23670-1224
Practice Address - Country:US
Practice Address - Phone:757-660-3157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty