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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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