Healthcare Provider Details

I. General information

NPI: 1104503606
Provider Name (Legal Business Name): SAFE SPACE THERAPY AND RETREATS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-7706
US

IV. Provider business mailing address

2651 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-7706
US

V. Phone/Fax

Practice location:
  • Phone: 678-209-6961
  • Fax:
Mailing address:
  • Phone: 678-209-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DANIELLE CURRIE
Title or Position: CEO/OWNER
Credential: LICSW
Phone: 678-209-6961