Healthcare Provider Details

I. General information

NPI: 1275344566
Provider Name (Legal Business Name): DRE'S HAVEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 MICCOSUKEE RD
TALLAHASSEE FL
32308-5458
US

IV. Provider business mailing address

PO BOX 4112
VALDOSTA GA
31604-4112
US

V. Phone/Fax

Practice location:
  • Phone: 850-228-2057
  • Fax:
Mailing address:
  • Phone: 407-312-5769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TONJA JONES-BLOUNT
Title or Position: EXECUTIVE PROGRAM DIRECTOR
Credential:
Phone: 407-312-5769