Healthcare Provider Details

I. General information

NPI: 1336824978
Provider Name (Legal Business Name): HAVEN PREGNANCY WELLNESS & WOMEN'S HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HIGHLAND PARK CV STE B
RIDGELAND MS
39157-6058
US

IV. Provider business mailing address

302 HIGHLAND PARK CV STE B
RIDGELAND MS
39157-6014
US

V. Phone/Fax

Practice location:
  • Phone: 601-255-8258
  • Fax:
Mailing address:
  • Phone: 601-707-3970
  • Fax: 601-510-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLENE HOOPER COLLIER
Title or Position: PHYSICIAN
Credential:
Phone: 601-707-3970