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General NPI Number Information
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NPI Number | 1639756794
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Entity Type | Organization
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Legal Business Name | THE SAFE SPACE THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1125 JEFFERSON DAVIS HWY STE 400
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-8449
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Country | US
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Telephone | 540-987-0362
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Fax |
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Provider Business Mailing Address
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Address Line | 2215 PLANK RD # 126
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-5226
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Country | US
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Telephone | 540-987-0362
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Fax | 855-364-3944
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | SHELA S WHITE
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Credential | LPC
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Telephone | 757-980-7301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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