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General NPI Number Information
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NPI Number | 1184326951
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Entity Type | Organization
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Legal Business Name | SAFE SPACE COUNSELING, PLLC.
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 22560 PHELPS ST
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036
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Country | US
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Telephone | 586-419-3851
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Fax |
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Provider Business Mailing Address
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Address Line | 13335 15 MILE RD # 216
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-4210
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Country | US
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Telephone | 586-419-3851
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Fax |
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Authorized Official
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Title or Position | RESIDENT AGENT
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Name | ANIKA DAVIS-WATLEY
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Credential | LMSW
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Telephone | 586-419-3851
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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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