Provider Demographics
NPI:1366022980
Name:SAFE SPACE COUNSELING CENTER
Entity type:Organization
Organization Name:SAFE SPACE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:813-830-3261
Mailing Address - Street 1:2957 FESTIVAL WAY STE 123 #1014
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601
Mailing Address - Country:US
Mailing Address - Phone:301-245-1339
Mailing Address - Fax:
Practice Address - Street 1:2957 FESTIVAL WAY STE 123 #1014
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601
Practice Address - Country:US
Practice Address - Phone:301-245-1339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCAY730004OtherCARE FIRST