Healthcare Provider Details

I. General information

NPI: 1568118438
Provider Name (Legal Business Name): THE SAFE SPACE THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 MARTIN BLVD STE 206
MIDDLE RIVER MD
21220-4103
US

IV. Provider business mailing address

6218 KENWOOD AVE
ROSEDALE MD
21237-2021
US

V. Phone/Fax

Practice location:
  • Phone: 410-971-0370
  • Fax:
Mailing address:
  • Phone: 410-971-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAMIA MCCALLUM
Title or Position: SOCIAL WORKER
Credential: LCSW-C
Phone: 410-971-0370