Organization
A SAFE PORT COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN FORREST DEMENT LCSW (SOLE MBR)
(662) 315-8357
Entity
Organization
Contact information
Practice address
4925 ATLANTIC VW, SAINT AUGUSTINE, FL 32080-7139
(662) 315-8357
Mailing address
4925 ATLANTIC VW, SAINT AUGUSTINE, FL 32080-7139
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/26/2023
Last updated
09/12/2024
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