Healthcare Provider Details

I. General information

NPI: 1043147242
Provider Name (Legal Business Name): A SAFE HAVEN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 N BROAD ST E STE 201
ANGIER NC
27501-5638
US

IV. Provider business mailing address

8 N BROAD ST E STE 201
ANGIER NC
27501-5638
US

V. Phone/Fax

Practice location:
  • Phone: 919-400-7863
  • Fax: 919-460-1895
Mailing address:
  • Phone: 919-375-8392
  • Fax: 919-460-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TREVOR A ULRICH
Title or Position: CLINIC DIRECTOR
Credential: CBLC, CCMA, CPSS
Phone: 919-375-8392