Organization Active NPI

Safe Space for Growth Counseling and Services

  • Mental Health Counselor
  • Concord, NC
National Provider Identifier
1356210694
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SAFE SPACE FOR GROWTH COUNSELING AND SERVICES
Practice address
159 Pounds Ave SW
Concord, NC 28025-4789
Phone
(704) 577-5356
NPI assigned
Nov 4, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Mia Alexis Johnson, LMCHCA
Title
Clinical Mental Health Counselor
Phone
(704) 577-5356

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

159 Pounds Ave SW
Concord, NC 28025-4789

Mailing address

159 Pounds Ave SW
Concord, NC 28025-4789
Phone (704) 577-5356

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1356210694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 POUNDS AVE SW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280254789",
            "telephone_number": "704-577-5356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 POUNDS AVE SW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280254789",
            "telephone_number": "704-577-5356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE SPACE FOR GROWTH COUNSELING AND SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-04",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MIA",
        "authorized_official_middle_name": "ALEXIS",
        "authorized_official_title_or_position": "CLINICAL MENTAL HEALTH COUNSELOR",
        "authorized_official_telephone_number": "704-577-5356",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMCHCA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.