| A Safe Port Counseling Llc | |
|
4925 Atlantic Vw Saint Augustine FL 32080-7139 | |
| (662) 315-8357 | |
| Not Available |
| Full Name | A Safe Port Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4925 Atlantic Vw, Saint Augustine, Florida |
| Authorized Official Name and Position | Justin Forrest Dement (SOLE MBR) |
| Authorized Official Contact | 6623158357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Safe Port Counseling Llc 4925 Atlantic Vw Saint Augustine FL 32080-7139 Ph: () - | A Safe Port Counseling Llc 4925 Atlantic Vw Saint Augustine FL 32080-7139 Ph: (662) 315-8357 |
| NPI Number | 1982380648 |
|---|---|
| Provider Enumeration Date | 06/26/2023 |
| Last Update Date | 09/12/2024 |
| Certification Date | 09/12/2024 |
| Medicare PECOS PAC ID | 9234580853 |
|---|---|
| Medicare Enrollment ID | O20240109000239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982380648 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Justin Forrest Dement |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285149823 PECOS PAC ID: 8224397104 Enrollment ID: I20180123000576 |
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