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Organization
YOUR SAFE SPACE
Active
Organization
YOUR SAFE SPACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN SIMMS LCPC (OWNER)
(301) 980-4581
Entity
Organization
Contact information
Practice address
10111 MARTIN LUTHER KING JR HWY STE 103, BOWIE, MD 20720-4225
(301) 459-0708
Mailing address
10111 MARTIN LUTHER KING JR HWY STE 103, BOWIE, MD 20720-4225
(301) 459-0708
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
819022400
—
MD
Enumeration date
04/25/2022
Last updated
04/25/2022
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