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General NPI Number Information
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NPI Number | 1568262962
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Entity Type | Organization
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Legal Business Name | SAFE SPACES HEAL, LLC
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 10130 MALLARD CREEK RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28262-6001
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Country | US
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Telephone | 347-742-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 117 HALSEY ST
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City | BROOKLYN
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State | NY
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Zip | 11216-2103
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Country | US
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Telephone | 347-742-4574
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | KONJE BYRON
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Credential |
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Telephone | 347-742-4574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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