Healthcare Provider Details

I. General information

NPI: 1033819446
Provider Name (Legal Business Name): HAVEN OF THE HEART COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W BROADWAY ST
NORTH LITTLE ROCK AR
72114-5628
US

IV. Provider business mailing address

2908 WATERFRONT CV
SHERWOOD AR
72120-8041
US

V. Phone/Fax

Practice location:
  • Phone: 501-487-1558
  • Fax:
Mailing address:
  • Phone: 501-920-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHALAE N HESSELBEIN
Title or Position: OWNER
Credential: LCSW
Phone: 501-920-9625