Physical Address Needs for Clinincians
Your Safe Space has physical office space and conference room for rent both physically and virtually.  All providers will have their individual assigned specific address and door codes upon approval.

Tell us what your needs are.
 
Contact us at: (301) 459-0708 or 301-202-1287  Admin@YourSafeSpace.org

Thank you for your participation.
Email *
Who needs the space? One person per request.
First Name *
Last Name
Licensing *
Required
Email *
Contact Phone (home or mobile ) *
Start Date preference *
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License type *
Do you have Insurance? With who and what is your policy number.
Policy Holders Full Name or Company Name on the policy.  If there are riders or covered employees/licensees, please name them.  
Are you currently under any kind of investigation or pending any kind of legal suspension or court cases/action? *
Please let us know what your needs are and how we can assist you.  Please be aware that this request is not an approval and all request are to be approved.  *
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