| A Safe Space Counseling Llc | |
|
1250 S Us Highway 17 92 Ste 150 Longwood FL 32750-5712 | |
| (407) 272-1715 | |
| (321) 972-5071 |
| Full Name | A Safe Space Counseling Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1250 S Us Highway 17 92 Ste 150, Longwood, Florida |
| Authorized Official Name and Position | Dora Lynn Henderson (OWNER) |
| Authorized Official Contact | 3217105649 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Safe Space Counseling Llc 1250 S Us Highway 17 92 Ste 150 Longwood FL 32750-5712 Ph: (321) 710-5649 | A Safe Space Counseling Llc 1250 S Us Highway 17 92 Ste 150 Longwood FL 32750-5712 Ph: (407) 272-1715 |
| NPI Number | 1417481235 |
|---|---|
| Provider Enumeration Date | 04/18/2017 |
| Last Update Date | 09/06/2024 |
| Certification Date | 09/06/2024 |
| Medicare PECOS PAC ID | 5193263929 |
|---|---|
| Medicare Enrollment ID | O20240812002882 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417481235 | NPI | - | NPPES |
| Provider Name | Dora Lynn Henderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346665296 PECOS PAC ID: 7810435641 Enrollment ID: I20240812003061 |
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