Healthcare Provider Details

I. General information

NPI: 1467978874
Provider Name (Legal Business Name): HAVEN COUNSELING GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 S COX ST
ASHEBORO NC
27203-6466
US

IV. Provider business mailing address

904 S COX ST
ASHEBORO NC
27203-6466
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-0208
  • Fax: 336-610-0209
Mailing address:
  • Phone: 270-871-8136
  • Fax: 336-610-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA13247
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BETHANY HANNAH HOUSTON
Title or Position: OWNER
Credential: LCMHC
Phone: 270-871-8136