Provider Demographics
NPI:1487280848
Name:A SAFE PLACE COUNSELLING AND COMMUNITY SUPPORT SERVICES L3C
Entity type:Organization
Organization Name:A SAFE PLACE COUNSELLING AND COMMUNITY SUPPORT SERVICES L3C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:EALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:313-384-4783
Mailing Address - Street 1:20222 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-2505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20216 ALBANY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-2505
Practice Address - Country:US
Practice Address - Phone:313-384-4783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty