Healthcare Provider Details

I. General information

NPI: 1316608334
Provider Name (Legal Business Name): SAFE SPACES COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 WHITEFIELD LN
BOSSIER CITY LA
71112-4277
US

IV. Provider business mailing address

4310 BARKSDALE BLVD
BOSSIER CITY LA
71112-3911
US

V. Phone/Fax

Practice location:
  • Phone: 225-588-3097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LENISE WASHINGTON
Title or Position: OWNER
Credential: LPC-S
Phone: 225-588-3097