Healthcare Provider Details

I. General information

NPI: 1598399438
Provider Name (Legal Business Name): SAFE ROUTES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 ASHGROVE DR
DUMFRIES VA
22025-1625
US

IV. Provider business mailing address

4411 ASHGROVE DR
DUMFRIES VA
22025-1625
US

V. Phone/Fax

Practice location:
  • Phone: 844-922-2855
  • Fax:
Mailing address:
  • Phone: 267-664-5641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. NIKKIMAH P DAVIS
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 571-229-7334