Provider Demographics
NPI:1780424671
Name:A SAFE PLACE WELLNESS SOLUTIONS LLC
Entity type:Organization
Organization Name:A SAFE PLACE WELLNESS SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMEKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APRN, PMHNP-BC
Authorized Official - Phone:601-600-2050
Mailing Address - Street 1:1044 MALLARD TRL
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-5152
Mailing Address - Country:US
Mailing Address - Phone:601-341-3760
Mailing Address - Fax:
Practice Address - Street 1:1014 ROBB ST STE D
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666-8033
Practice Address - Country:US
Practice Address - Phone:601-600-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty