| Entity Name: | A SAFE SPACE COUNSELING, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Apr 2017 (8 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 26 Mar 2021 (4 years ago) |
| Document Number: | L17000081848 |
| FEI/EIN Number | 82-1193781 |
| Mail Address: | 142 CIRCLE HILL ROAD, SANFORD, FL 32773 |
| Address: | 1250 S US HWY 1792, SUITE 150, Longwood, FL 32750 |
| ZIP code: | 32750 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417481235 | 2017-04-18 | 2024-09-06 | 1250 S US HIGHWAY 17 92 STE 150, LONGWOOD, FL, 327505712, US | 1250 S US HIGHWAY 17 92 STE 150, LONGWOOD, FL, 327505712, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 321-710-5649 |
| Fax | 3219725071 |
| Phone | +1 407-272-1715 |
Authorized person
| Name | DORA LYNN HENDERSON |
| Role | OWNER |
| Phone | 3217105649 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| License Number | MH12311 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| HENDERSON, DARRYL R | Agent | 142 CIRCLE HILL ROAD, SANFORD, FL 32773 |
| Name | Role | Address |
|---|---|---|
| HENDERSON, DORA | Manager | 142 CIRCLE HILL ROAD, SANFORD, FL 32773 |
| Name | Role | Address |
|---|---|---|
| Henderson, Darryl | Authorized Member | 142 CIRCLE HILL ROAD, SANFORD, FL 32773 |
| EDMARK, SYLVIA | Authorized Member | 2509 S DENNIS STREET, KENNEWICK, WA 99337 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000086540 | BRAIN WAVES CREATIONS BY DORA | ACTIVE | 2024-07-19 | 2029-12-31 | No data | 142 CIRCLE HILL ROAD, SANFORD, FL, 32773 |
| G24000056286 | ACADEMY OF PUPPET PLAY THERAPY | ACTIVE | 2024-04-29 | 2029-12-31 | No data | 142 CIRCLE HILL ROAD, SANFORD, FL, 32773 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2021-03-26 | No data | No data |
| LC AMENDMENT | 2020-12-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-03 | 1250 S US HWY 1792, SUITE 150, Longwood, FL 32750 | No data |
| LC AMENDMENT | 2017-04-27 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-07-24 |
| ANNUAL REPORT | 2024-02-24 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-03-12 |
| LC Amendment | 2021-03-26 |
| ANNUAL REPORT | 2021-02-13 |
| LC Amendment | 2020-12-28 |
| ANNUAL REPORT | 2020-02-03 |
| ANNUAL REPORT | 2019-03-31 |
| ANNUAL REPORT | 2018-02-22 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
