Organization
A SAFE SPACE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORA LYNN HENDERSON LMHC (OWNER)
(321) 710-5649
Entity
Organization
Contact information
Practice address
1250 S US HIGHWAY 17 92 STE 150, LONGWOOD, FL 32750-5712
(407) 272-1715
(321) 972-5071
Mailing address
1250 S US HIGHWAY 17 92 STE 150, LONGWOOD, FL 32750-5712
(321) 710-5649
(321) 972-5071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
MH12311
FL
Other
Enumeration date
04/18/2017
Last updated
09/06/2024
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