A Safe Port Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

A SAFE PORT COUNSELING LLC

Practice address

4925 Atlantic VW
Saint Augustine, FL 32080-7139

Phone

(662) 315-8357

NPI assigned

Jun 26, 2023

Last updated

Sep 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Justin Forrest Dement, LCSWNPI 1285149823

Title

Sole MBR

Phone

(662) 315-8357

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Justin Forrest Dement, LCSW

  • Clinical Social Worker
  • St Augustine, FL
  • NPI 1285149823
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1982380648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4925 ATLANTIC VW",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320807139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 ATLANTIC VW",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320807139",
            "telephone_number": "662-315-8357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A SAFE PORT COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "DEMENT",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "FORREST",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "662-315-8357",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.