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General NPI Number Information
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NPI Number | 1992098446
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Entity Type | Organization
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Legal Business Name | SAFE HARBOR COUNSELING, INC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 2692 US HIGHWAY I, SOUTH SUITE 205
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City | ST AUGUSTINE
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State | FL
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Zip | 32086
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Country | US
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Telephone | 904-669-5908
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Fax | 904-794-4225
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Provider Business Mailing Address
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Address Line | 2692 US HIGHWAY I, SOUTH SUITE 205
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City | ST AUGUSTINE
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State | FL
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Zip | 32086
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Country | US
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Telephone | 904-669-5908
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Fax | 904-794-4225
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. APRIL LIDDLE
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Credential | LCSW
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Telephone | 904-669-5908
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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 | SW70408
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License Number State | FL
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