| Safe Space Counseling, Pllc. | |
|
22560 Phelps St Clinton Township MI 48036 | |
| (586) 419-3851 | |
| Not Available |
| Full Name | Safe Space Counseling, Pllc. |
|---|---|
| Speciality | Social Worker |
| Location | 22560 Phelps St, Clinton Township, Michigan |
| Authorized Official Name and Position | Anika Davis-watley (RESIDENT AGENT) |
| Authorized Official Contact | 5864193851 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Safe Space Counseling, Pllc. 13335 15 Mile Rd # 216 Sterling Heights MI 48312-4210 Ph: (586) 419-3851 | Safe Space Counseling, Pllc. 22560 Phelps St Clinton Township MI 48036 Ph: (586) 419-3851 |
| NPI Number | 1184326951 |
|---|---|
| Provider Enumeration Date | 03/17/2023 |
| Last Update Date | 12/14/2023 |
| Certification Date | 12/14/2023 |
| Medicare PECOS PAC ID | 5395195879 |
|---|---|
| Medicare Enrollment ID | O20231226000329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184326951 | NPI | - | NPPES |
| 1932587995 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Anika Davis-watley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932587995 PECOS PAC ID: 8022487917 Enrollment ID: I20221215002862 |
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