Healthcare Provider Details

I. General information

NPI: 1871482000
Provider Name (Legal Business Name): SAFE HEAD SPACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E SAINT JOHN ST
TARBORO NC
27886-4413
US

IV. Provider business mailing address

1007 EAST AVE
TARBORO NC
27886-3239
US

V. Phone/Fax

Practice location:
  • Phone: 919-299-0944
  • Fax:
Mailing address:
  • Phone: 919-299-0944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: KEISHA FERREIRA
Title or Position: EXECUTIVE DIRECTOR
Credential: LCAS
Phone: 252-452-1661