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General NPI Number Information
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NPI Number | 1750092896
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Entity Type | Organization
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Legal Business Name | A SAFE PLACE EMPOWERMENT NETWORK
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 260 W MAIN AVE STE A
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City | GASTONIA
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State | NC
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Zip | 28052-4166
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Country | US
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Telephone | 929-451-4290
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Fax | 704-802-1631
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Provider Business Mailing Address
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Address Line | 260 W MAIN AVE STE A
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City | GASTONIA
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State | NC
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Zip | 28052-4166
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Country | US
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Telephone | 704-498-8898
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Fax | 704-802-1631
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. WANDA JONES
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Credential | LCSW, LCSA, PHD
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Telephone | 929-451-4290
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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