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General NPI Number Information
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NPI Number | 1487280848
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Entity Type | Organization
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Legal Business Name | A SAFE PLACE COUNSELLING AND COMMUNITY SUPPORT SERVICES L3C
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Dates
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Enumeration Date | 03/18/2020
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 20216 ALBANY ST
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City | DETROIT
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State | MI
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Zip | 48234-2505
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Country | US
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Telephone | 313-384-4783
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Fax |
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Provider Business Mailing Address
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Address Line | 20222 ALBANY ST
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City | DETROIT
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State | MI
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Zip | 48234-2505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | TINA DIANE EALEY
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Credential | MA
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Telephone | 313-384-4783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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