Healthcare Provider Details

I. General information

NPI: 1558061093
Provider Name (Legal Business Name): HAVEN WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 POMONA RD
ANN ARBOR MI
48103-3044
US

IV. Provider business mailing address

1145 POMONA RD
ANN ARBOR MI
48103-3044
US

V. Phone/Fax

Practice location:
  • Phone: 734-646-0410
  • Fax:
Mailing address:
  • Phone: 734-646-0410
  • 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 Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIRBY N PATERSON
Title or Position: OWNER
Credential: LMSW
Phone: 734-646-0410