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General NPI Number Information
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NPI Number | 1144164229
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Entity Type | Organization
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Legal Business Name | A SAFE SPACE THERAPEUTIC SERVICES, PLLC
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Dates
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Enumeration Date | 04/17/2026
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Last Update Date | 04/17/2026
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Provider Practice Location Address
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Address Line | 2015 COPPER LEAF PKWY
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City | DURHAM
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State | NC
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Zip | 27703-7707
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Country | US
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Telephone | 919-948-0105
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Fax |
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Provider Business Mailing Address
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Address Line | 3064 WAKE FOREST RD # 1180
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City | RALEIGH
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State | NC
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Zip | 27609-7844
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Country | US
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Telephone | 919-948-0105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAKEDA MULDROW
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Credential | LCSW
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Telephone | 919-948-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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